title: Perforation of the IVC: rule rather than exception after longer indwelling times for the Günther Tulip and Celect retrievable filters.
abstract: OBJECTIVE
  This study was designed to assess the incidence, magnitude, and impact upon retrievability of vena caval perforation by Günther Tulip and Celect conical inferior vena cava (IVC) filters on computed tomographic (CT) imaging.
  
  
  METHODS
  Günther Tulip and Celect IVC filters placed between July 2007 and May 2009 were identified from medical records. Of 272 IVC filters placed, 50 (23 Günther Tulip, 46%; 27 Celect, 54%) were retrospectively assessed on follow-up abdominal CT scans performed for reasons unrelated to the filter. Computed tomography scans were examined for evidence of filter perforation through the vena caval wall, tilt, or pericaval tissue injury. Procedure records were reviewed to determine whether IVC filter retrieval was attempted and successful.
  
  
  RESULTS
  Perforation of at least one filter component through the IVC was observed in 43 of 50 (86%) filters on CT scans obtained between 1 and 880 days after filter placement. All filters imaged after 71 days showed some degree of vena caval perforation, often as a progressive process. Filter tilt was seen in 20 of 50 (40%) filters, and all tilted filters also demonstrated vena caval perforation. Transjugular removal was attempted in 12 of 50 (24%) filters and was successful in 11 of 12 (92%).
  
  
  CONCLUSIONS
  Longer indwelling times usually result in vena caval perforation by retrievable Günther Tulip and Celect IVC filters. Although infrequently reported in the literature, clinical sequelae from IVC filter components breaching the vena cava can be significant. We advocate filter retrieval as early as clinically indicated and increased attention to the appearance of IVC filters on all follow-up imaging studies.
authors: Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M361, San Francisco, CA 94143-0628, USA. jeremy.durack@ucsf.edu
authors: Jeremy C
authors: JC
authors: Durack
authors: Antonio C
authors: AC
authors: Westphalen
authors: Stephanie
authors: S
authors: Kekulawela
authors: Shiv B
authors: SB
authors: Bhanu
authors: David E
authors: DE
authors: Avrin
authors: Roy L
authors: RL
authors: Gordon
authors: Robert K
authors: RK
authors: Kerlan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal / Q000379:methods; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016306:Vena Cava Filters / Q000009:adverse effects* / Q000145:classification; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult