Indications and Outcomes of Open Inferior Vena Cava Filter Removal

Indications and Outcomes of Open Inferior Vena Cava Filter Removal

Volume 41, May 2017 Vascular and Endovascular Surgery Society 41st Annual Meeting 17 endovascular procedures for claudication in patients who contin...

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Volume 41, May 2017

Vascular and Endovascular Surgery Society 41st Annual Meeting 17

endovascular procedures for claudication in patients who continued to smoke (29% vs. 46%, p¼.03), and prescribe an initial antihyperlipid medication (65% vs. 39%, p¼.0018). Conclusions: Tobacco dependence remains a critical issue for vascular surgery patients, however, there is wide variation in cessation techniques used. The majority of surgeons are not well versed in cessation techniques and risk factor modification, and efforts should thus be made to provide this education in vascular surgery training programs. http://dx.doi.org/10.1016/j.avsg.2017.03.138

INDICATIONS AND OUTCOMES OF OPEN INFERIOR VENA CAVA FILTER REMOVAL Shaikh Afaq, Samuel S. Leake, Harleen K. Sandhu, Naveed U. Saqib, Ali Azizzadeh, and Kristofer M. Charlton-Ouw University of Texas, Houston, TX. Introduction and Objectives: Despite recommendations for retrieval of inferior vena cava (IVC) filters, most are not removed in a timely manner. Longer IVC filter dwell times are associated with caval wall perforation and tilting that make retrieval difficult. Open surgical IVC filter removal is reserved for patients with symptoms/complications referable to the filter, such as chronic back and abdominal pain. We present our management algorithm and surgical technique. Methods: Our database was searched for IVC filter removals from 2010-2016. All open surgical cases were extracted and imaging reviewed. In most cases, we perform a 10-cm mini-laparotomy and retract the duodenum without mobilizing the right colon. We minimize dissection of the IVC if there are dense adhesions or scarring by using sponge sticks for proximal and distal control. An endovenectomy is performed as needed and the cavotomy primarily repaired without patching. Results: We retrieved filters from 207 patients during the study period. Seven patients required open surgical removal. One patient had 2 filters (Figure) and another had 3 filters. Except for 2 cases referred to us with urgent complications, the remaining patients all suffered from chronic back or abdominal pain. The symptomatic patients failed previous attempts at percutaneous retrieval and all had significant filter strut penetration through the caval wall into adjacent structures (Table). Postoperatively, all patients had relief of pain. Conclusion: Most patients can have optional IVC filters percutaneously retrieved. Patients who fail percutaneous IVC filter retrieval can expect low morbidity and prompt resolution of symptoms after open surgical removal. http://dx.doi.org/10.1016/j.avsg.2017.03.139

A NOVEL OFF-THE-SHELF TECHNIQUE FOR ENDOVASCULAR REPAIR OF TYPE III AND IV THORACOABDOMINAL AORTIC ANEURYSMS USING THE GORE EXCLUDER AND VIABAHN BRANCHES Mathew Wooster, Paul Armstrong, and Murray Shames University of South Florida, Tampa, FL. Objective: To describe a novel off-the-shelf technique to repair type III and type IV thoracoabdominal aortic aneurysms (TAAA) in absence of available prefabricated branched devices. Methods: All patients undergoing endovascular repair of type III and IV TAAAs using this technique were included from a prospectively maintained registry. The proximal bifurcated device is deployed with the contralateral gate above the celiac axis. From an axillary approach, through the contralateral gate (and including a single snorkel along side the mainbody), 3 or 4 renovisceral artery branches are sequentially cannulated and stented using Viabahn covered stents. All branches are simultaneous balloon dilated to ensure gutter seal in the contralateral gate. Via the ipsilateral limb, the device can then be extended with a flared iliac extension and/or additional bifurcated device to obtain seal in the distal aorta or iliac arteries. Results: Eight patients (male ¼6, mean 78 years of age) were identified since January 2015. All underwent repair