title: Respiratory-Induced Haemodynamic Changes: A Contributing Factor to IVC Filter Penetration.
abstract: OBJECTIVE
  The purpose of the study is to evaluate the influence of respiratory-induced vena caval hemodynamic changes on filter migration/penetration.
  
  
  METHODS
  After placement of either a Gunther Tulip or Celect IVC filter, 101 consecutive patients scheduled for filter retrieval were prospectively enrolled in this study. Pre-retrieval CT scans were used to assess filter complications and to calculate cross-sectional area in three locations: at level of filter strut fixation, 3 cm above and 3 cm below. A 3D finite element simulation was constructed on these data and direct IVC pressure was recorded during filter retrieval. Cross-sectional areas and pressures of the vena cava were measured during neutral breathing and in Valsalva maneuver and identified filter complications were recorded. A statistical analysis of these variables was then performed.
  
  
  RESULTS
  During Valsalva maneuvers, a 60 % decrease of the IVC cross-sectional area and a fivefold increase in the IVC pressure were identified (p < 0.001). There was a statistically significant difference in the reduction of the cross-sectional area at the filter strut level (p < 0.001) in patient with filter penetration. Difficulty in filter retrieval was higher in penetrated or tilted filters (p < 0.001; p = 0.005). 3D computational models showed significant IVC deformation around the filter during Valsalva maneuver.
  
  
  CONCLUSIONS
  Caval morphology and hemodynamics are clearly affected by Valsalva maneuvers. A physiological reduction of IVC cross-sectional area is associated with higher risk of filter penetration, despite short dwell times. Physiologic data should be used to improve future filter designs to remain safely implanted over longer dwell times.
authors: Minimally Invasive Techniques Research Group (GITMI), Universidad de Zaragoza, Miguel Servet, 177, 50013, Saragossa, Spain. alaborda@unizar.es.
authors: Alicia
authors: A
authors: Laborda
authors: Division of Vascular and Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3651, Stanford, CA, 94305-5642, USA. wkuo@stanford.edu.
authors: William T
authors: WT
authors: Kuo
authors: Minimally Invasive Techniques Research Group (GITMI), Universidad de Zaragoza, Miguel Servet, 177, 50013, Saragossa, Spain. ignacio.ioakim@hotmail.es.
authors: Ignatios
authors: I
authors: Ioakeim
authors: Unit of Infectious Diseases and Epidemiology, Department of Animal Pathology, Universidad de Zaragoza, Calle Miguel Servet, 177, 50013, Saragossa, Spain. deblas@unizar.es.
authors: Ignacio
authors: I
authors: De Blas
authors: Department of Mechanical, Energy and Materials Engineering, Universidad Pública de Navarra, Campus Arrosadía, Edif. de los Pinos, 31006, Pamplona, Spain. mauro.malve@unavarra.es.|CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Saragossa, Spain. mauro.malve@unavarra.es.
authors: Mauro
authors: M
authors: Malvè
authors: Minimally Invasive Techniques Research Group (GITMI), Universidad de Zaragoza, Miguel Servet, 177, 50013, Saragossa, Spain. celialahuerta@gmail.com.
authors: Celia
authors: C
authors: Lahuerta
authors: Minimally Invasive Techniques Research Group (GITMI), Universidad de Zaragoza, Miguel Servet, 177, 50013, Saragossa, Spain. mgregori@unizar.es.|CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Saragossa, Spain. mgregori@unizar.es.
authors: Miguel A
authors: MA
authors: De Gregorio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012119:Respiration; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014636:Valsalva Maneuver / Q000502:physiology; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Complications; Deep vein thrombosis; Penetration; Valsalva maneuver; Vena cava filter