here goes:Preop Dx: IVC filter placement for previous DVT in need of retrieval
Postop Dx: IVC filter placement for previous DVT in need of retrieval
IVC venogram was initially performed in AP which showed the filter in good positon. There was no sign of any thrombus in the IVC. Follow up studies in lateral projections and oblique projections showed that the filter was tilted posteriorly with its hook embedded in the wall. After attempted right femoral access, venogram was performed through a needle that showed that the femoral vein was occluded as well as the right iliac veins with contralateral flow through suprapubic conduits. This was confirmed later with a catheter from the neck after attempting a common iliac catheterization down the right side which was occluded. The left iliac vein was widely patent in the common iliac.
Procedure in detail: Patient taken to angio suite, placed in supine position, IV sedation, neck was prepped and draped in standard fashion. Following this under US guidance, the right internal juglar vein was accessed with 19-guage needle & 0.038 j-starter wire was inserted. This was then exchanged over a catheter to a Benston wire which was used to catheterize the inferior vena cava and a long retrieval 10-french sheath was placed into the inferior vena cava above the filter. We initially tried to snare the filter with the snare in the kit and after several attempts we then performed oblique and lateral projections which showed that the filter had a posterior tilt to it and that the hook appeared embedded in the wall of the vein. We then tried various maneuvers as well as various Amplatz gooseneck snare wires and a figure-of-eight snare as well but could not get it hooked on the hook of the filter. We then tried using a stiffer wire to move the filter away from the wall but proved unsuccessful from the neck approach. We then attempted to place the sheath into the right femoral vein but this proved to be occluded, so left femoral sheath was placed which was 8-french in size. This was flashed with saline. The patient was given 2000 units of heparin iv at this point. We then used a 0.035 super stiff Amplatz wire and eventually a 12mm x 4cm angioplasty balloon to attempt to move the filter at the back wall of the vena cava and this appeared to initially work, however, even after these maneuvers we were unable to snare with multiple snares the hook of the filter and it was felt that it was likely still embedded in the wall. At this point about 2 hrs it passed into the case with multiple attempts at retrieval, we decided to abandon retrieval of this filter. The sheath was peeled and pressure was held for 5 minutes until hemostatic. Sterile dressing was applied. The patient was taken to the outpatient tolerating the procedure well.
37203-53/75961 (discontinued procedure)
36010-59 for second access cath to IVC
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