title: The Günther Tulip retrievable filter: prolonged temporary filtration by repositioning within the inferior vena cava.
abstract: OBJECTIVE
  To report experience with the retrievable Günther Tulip filter (GTF) as a means of temporary caval filtration for the prevention of pulmonary embolism (PE) with use of a technique that prolongs filter dwell time beyond 14 days.
  
  
  METHODS
  Eighty-eight GTFs were implanted in 87 patients. The GTFs were placed with the intention of retrieval in all patients within 14 days after initial implantation. In 23 of the 87 patients (26%), there was a need to prolong temporary caval filtration beyond the recommended period of 14 days. This was successfully achieved with use of percutaneous techniques from the right internal jugular vein whereby the filter was repositioned to a different location within the inferior vena cava (IVC) before definitive device removal.
  
  
  RESULTS
  Of 88 GTFs implanted in 87 patients, 70 were successfully retrieved and 18 were left in place permanently. Forty-seven filters in 46 patients were removed after initial implantation with no need for percutaneous repositioning within the IVC to prolong dwell time (mean dwell time, 13 days). In the 23 patients who required repositioning of 23 GTFs within the IVC to prolong temporary caval filtration, the mean dwell time was 34.8 days; the mean number of repositioning procedures was 1.5, the mean time between repositioning procedures was 13.8 days, and the mean fluoroscopy time was 4.4 minutes in patients in whom filter retrieval was attempted. One patient underwent placement and subsequent removal of the GTF twice for perioperative prophylaxis against PE on two separate occasions. No filters were misplaced in an unintended location or tilted (>15 degrees ) in relation to the main caval axis after deployment. In one patient, a GTF became permanently fixed in the IVC 16 days after initial implantation and could not be removed percutaneously. Nine patients had mild or moderate-sized cervical hematomas. One patient had recurrent asymptomatic PE 2 months after filter insertion.
  
  
  CONCLUSIONS
  Dwell times of 14 days can be achieved in most patients before device removal. Prolongation of the dwell time beyond 14 days can be safely and easily achieved by performing percutaneous repositioning of the device within the IVC via a jugular approach.
authors.affiliation: Department of Interventional Radiology, Minimally Invasive Techniques Unit, University of Zaragoza, Zaragoza, Spain. madgariza@separ.es
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: de Gregorio
authors.forename: Pablo
authors.initials: P
authors.lastname: Gamboa
authors.forename: María José
authors.initials: MJ
authors.lastname: Gimeno
authors.forename: Blanca
authors.initials: B
authors.lastname: Madariaga
authors.forename: Ricardo
authors.initials: R
authors.lastname: Tobío
authors.forename: Marcos
authors.initials: M
authors.lastname: Herrera
authors.forename: Joaquín
authors.initials: J
authors.lastname: Medrano
authors.forename: Antonio
authors.initials: A
authors.lastname: Mainar
authors.forename: Ramón
authors.initials: R
authors.lastname: Alfonso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000517:prevention & control*; D012189:Retrospective Studies; D016306:Vena Cava Filters