title: Fracture and distant migration of the Bard Recovery filter: a retrospective review of 363 implantations for potentially life-threatening complications.
abstract: OBJECTIVE
  To report the occurrence of fracture of the Recovery filter and incidence of potentially life-threatening complications associated with fractured fragment migration.
  
  
  METHODS
  A retrospective study of images obtained after placement of Recovery inferior vena cava (IVC) filters from 2003 to 2006 was conducted at a single tertiary-care center. Images were reevaluated for fracture and migration; complications related to filter fracture were investigated. Kaplan-Meier survival analysis was performed to investigate the relationship between time in situ and fracture.
  
  
  RESULTS
  A total of 363 Recovery filters were placed; 97 were retrieved, leaving 266 filters in situ (135 patients subsequently died of other causes). The following images were evaluated: 130 chest computed tomography (CT) scans, 153 abdominal CT scans, 254 chest radiographs, 148 radiographs of the abdomen/pelvis, and 106 cavagrams. Mean imaging follow-up interval was 18.4 months (maximum, 81.3 mo). No en bloc migration occurred outside the IVC. Twenty-six limb fractures (all short limbs) were identified in 20 patients; the earliest occurred at 4.1 months. Eight fragment migrations occurred into pulmonary arteries, seven into iliac/femoral veins, one into the right ventricle, and one into the renal vein. Seven fragments were intracaval near the filter, one was extracaval, and one could not be located. Kaplan-Meier survival estimates predicted a fracture rate of 40% at 5.5 years. Of the 20 patients with filter fractures, three died of unrelated causes and 17 remain asymptomatic.
  
  
  CONCLUSIONS
  Recovery filter fractures occurred at the short limb only, with a suggested 5.5-year fracture risk of 40%. No life-threatening events occurred in patients with filter fracture.
authors.affiliation: Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 441952, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Tam
authors.forename: James
authors.initials: J
authors.lastname: Spain
authors.forename: Michael
authors.initials: M
authors.lastname: Lieber
authors.forename: Michael
authors.initials: M
authors.lastname: Geisinger
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sands
authors.forename: Weiping
authors.initials: W
authors.lastname: Wang
mesh_terms: D015897:Comorbidity; D020878:Device Removal / Q000401:mortality*; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality*; D015995:Prevalence; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000706:statistics & numerical data*; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000401:mortality*