Korean J Radiol.  2012 Aug;13(4):483-491. 10.3348/kjr.2012.13.4.483.

Introducer Curving Technique for the Prevention of Tilting of Transfemoral Gunther Tulip Inferior Vena Cava Filter

• Xiao L
• Huang DS
• Shen J
• Tong JJ

• KMID: 1383861
• DOI: http://doi.org/10.3348/kjr.2012.13.4.483

Abstract

OBJECTIVE
To determine whether the introducer curving technique is useful in decreasing the degree of tilting of transfemoral Tulip filters.
MATERIALS AND METHODS
The study sample group consisted of 108 patients with deep vein thrombosis who were enrolled and planned to undergo thrombolysis, and who accepted transfemoral Tulip filter insertion procedure. The patients were randomly divided into Group C and Group T. The introducer curving technique was Adopted in Group T. The post-implantation filter tilting angle (ACF) was measured in an anteroposterior projection. The retrieval hook adhering to the vascular wall was measured via tangential cavogram during retrieval.
RESULTS
The overall average ACF was 5.8 +/- 4.14 degrees. In Group C, the average ACF was 7.1 +/- 4.52 degrees. In Group T, the average ACF was 4.4 +/- 3.20 degrees. The groups displayed a statistically significant difference (t = 3.573, p = 0.001) in ACF. Additionally, the difference of ACF between the left and right approaches turned out to be statistically significant (7.1 +/- 4.59 vs. 5.1 +/- 3.82, t = 2.301, p = 0.023). The proportion of severe tilt (ACF > or = 10degrees) in Group T was significantly lower than that in Group C (9.3% vs. 24.1%, chi2 = 4.267, p = 0.039). Between the groups, the difference in the rate of the retrieval hook adhering to the vascular wall was also statistically significant (2.9% vs. 24.2%, chi2 = 5.030, p = 0.025).
CONCLUSION
The introducer curving technique appears to minimize the incidence and extent of transfemoral Tulip filter tilting.

Keyword

Tilt; Prevention; Gunther Tulip filter, caval; Transfemoral; Randomized

MeSH Terms

Blood Vessel Prosthesis Implantation/instrumentation/*methods
Chi-Square Distribution
Device Removal
Double-Blind Method
Female
Femoral Vein
Humans
Male
Middle Aged
Prosthesis Design
Pulmonary Embolism/*prevention & control
Statistics, Nonparametric
Thrombolytic Therapy
Treatment Outcome
*Vena Cava Filters
Venous Thrombosis/*complications

Figure

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  Fig. 1 Photo and line art of curved Günther Tulip filter introducer with filter. A. Photo. B. Line art.

• 

  Fig. 2 Procedural step of introducer curving technique. A. Anteroposterior cavogram is performed to document angle (ACI) between inferior vena cava (IVC) and approached iliac vein axis and distance (DRF) between level of lower renal vein confluence and furcation of IVC. B. Metal introducer is curved via introducer curving technique. C. 8.5 Fr sheath is inserted into IVC and filter is placed into sheath and transported into IVC. D. Curved introducer is rotated and orientation of superior segment of introducer is adjusted to parallel with longitude axis of IVC. E. Red hub is loosened and pulled forwards to release filter.

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  Fig. 3 Concepts and measurement methods of tilting angle (ACF). A. A1 is angle between inferior vena cava axis (A Line) and line (B Line) between spinous processes of L1 and L4 (when vertex of angle locates superior, value of angle is plus). B. A2 is angle between axis of Günther Tulip filter (C Line) and B Line (when vertex of angle locates superior, value of angle is plus). ACF = A1-A2 (when value of ACF is plus, apex of filter tilts to right)

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  Fig. 4 Relationships between distance (DCH) between caval center and retrieval hook and distance (DTH) between tip of curved angle and apical retrieval hook when introducer curving technique of Günther Tulip filter is adopted. A. When DTH is suitable, DCH is nearly zero. B. When DTH is insufficient, DCH will increase and tilting angle (ACF) will increase. C. When DTH is too high, DCH will increase and ACF will increase.

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