Richard D Kang, Philip Schuchardt, Jonathan Charles, Premsai Kumar, Elena Drews, Stephanie Kazi, Andres DePalma, Adam Fang, Aislynn Raymond, Cliff Davis, Kamal Massis, Glenn Hoots, Rahul Mhaskar, Nariman Nezami, Jamil Shaikh
{"title":"下腔静脉滤器回收使用支气管内钳的预测因素:当圈套回收失败。","authors":"Richard D Kang, Philip Schuchardt, Jonathan Charles, Premsai Kumar, Elena Drews, Stephanie Kazi, Andres DePalma, Adam Fang, Aislynn Raymond, Cliff Davis, Kamal Massis, Glenn Hoots, Rahul Mhaskar, Nariman Nezami, Jamil Shaikh","doi":"10.1186/s42155-023-00392-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Endobronchial forceps are commonly used for complex IVC filter removal and after initial attempts at IVC filter retrieval with a snare have failed. Currently, there are no clear guidelines to help distinguish cases where primary removal should be attempted with standard snare technique or whether attempts at removal should directly be started with forceps. This study is aimed to identify clinical and imaging predictors of snare failure which necessitate conversion to endobronchial forceps.</p><p><strong>Methods: </strong>Retrospective analysis of 543 patients who underwent IVC filter retrievals were performed at three large quaternary care centers from Jan 2015 to Jan 2022. Patient demographics and IVC filter characteristics on cross-sectional images (degree of tilt, hook embedment, and strut penetration, etc.) were reviewed. Binary multivariate logistic regression was used to identify predictors of IVC filter retrieval where snare retrieval would fail.</p><p><strong>Results: </strong>Thirty seven percent of the patients (n = 203) necessitated utilization of endobronchial forceps. IVC filter hook embedment (OR:4.55; 95%CI: 1.74-11.87; p = 0.002) and strut penetration (OR: 56.46; 95% CI 20.2-157.7; p = 0.001) were predictors of snare failure. In contrast, total dwell time, BMI, and degree of filter tilt were not associated with snare failure. Intraprocedural conversion from snare to endobronchial forceps was significantly associated with increased contrast volume, radiation dose, and total procedure times (p < 0.05).</p><p><strong>Conclusion: </strong>IVC filter hook embedment and strut penetration were predictors of snare retrieval failure. Intraprocedural conversion from snare to endobronchial forceps increased contrast volume, radiation dose, and total procedure time. When either hook embedment or strut penetration is present on pre-procedural cross-sectional images, IVC filter retrieval should be initiated using endobronchial forceps.</p><p><strong>Level of evidence: </strong>Level 3, large multicenter retrospective cohort.</p>","PeriodicalId":52351,"journal":{"name":"CVIR Endovascular","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10640549/pdf/","citationCount":"0","resultStr":"{\"title\":\"Predictors of endobronchial forceps utilization for inferior vena cava filter retrieval: when snare retrieval fails.\",\"authors\":\"Richard D Kang, Philip Schuchardt, Jonathan Charles, Premsai Kumar, Elena Drews, Stephanie Kazi, Andres DePalma, Adam Fang, Aislynn Raymond, Cliff Davis, Kamal Massis, Glenn Hoots, Rahul Mhaskar, Nariman Nezami, Jamil Shaikh\",\"doi\":\"10.1186/s42155-023-00392-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Endobronchial forceps are commonly used for complex IVC filter removal and after initial attempts at IVC filter retrieval with a snare have failed. Currently, there are no clear guidelines to help distinguish cases where primary removal should be attempted with standard snare technique or whether attempts at removal should directly be started with forceps. This study is aimed to identify clinical and imaging predictors of snare failure which necessitate conversion to endobronchial forceps.</p><p><strong>Methods: </strong>Retrospective analysis of 543 patients who underwent IVC filter retrievals were performed at three large quaternary care centers from Jan 2015 to Jan 2022. Patient demographics and IVC filter characteristics on cross-sectional images (degree of tilt, hook embedment, and strut penetration, etc.) were reviewed. Binary multivariate logistic regression was used to identify predictors of IVC filter retrieval where snare retrieval would fail.</p><p><strong>Results: </strong>Thirty seven percent of the patients (n = 203) necessitated utilization of endobronchial forceps. IVC filter hook embedment (OR:4.55; 95%CI: 1.74-11.87; p = 0.002) and strut penetration (OR: 56.46; 95% CI 20.2-157.7; p = 0.001) were predictors of snare failure. In contrast, total dwell time, BMI, and degree of filter tilt were not associated with snare failure. Intraprocedural conversion from snare to endobronchial forceps was significantly associated with increased contrast volume, radiation dose, and total procedure times (p < 0.05).</p><p><strong>Conclusion: </strong>IVC filter hook embedment and strut penetration were predictors of snare retrieval failure. Intraprocedural conversion from snare to endobronchial forceps increased contrast volume, radiation dose, and total procedure time. When either hook embedment or strut penetration is present on pre-procedural cross-sectional images, IVC filter retrieval should be initiated using endobronchial forceps.</p><p><strong>Level of evidence: </strong>Level 3, large multicenter retrospective cohort.</p>\",\"PeriodicalId\":52351,\"journal\":{\"name\":\"CVIR Endovascular\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2023-11-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10640549/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CVIR Endovascular\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s42155-023-00392-9\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CVIR Endovascular","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s42155-023-00392-9","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景:支气管内钳通常用于复杂的下腔静脉滤器去除,在最初尝试用圈套取出下腔静脉滤器失败后。目前,没有明确的指导方针来帮助区分应该用标准的圈套技术尝试首次摘除还是应该直接用镊子开始摘除的情况。这项研究的目的是确定临床和影像学预测陷阱失效,需要转换为支气管内钳。方法:回顾性分析2015年1月至2022年1月在三家大型四级医疗中心进行的543例下腔静脉滤器检索患者。回顾了患者人口统计学特征和横截面图像上的IVC滤波器特征(倾斜程度,钩子嵌入和支柱穿透等)。二元多元逻辑回归用于识别IVC滤波器检索中陷阱检索失败的预测因子。结果:有37%(203例)的患者需要使用支气管内钳。IVC滤波器挂钩嵌入(OR:4.55;95%置信区间:1.74—-11.87;p = 0.002)和支柱穿透度(OR: 56.46;95% ci 20.2-157.7;P = 0.001)是陷阱失效的预测因子。相比之下,总停留时间、体重指数和过滤器倾斜程度与陷阱失效无关。术中从陷阱钳到支气管内钳的转换与造影剂体积、辐射剂量和总手术时间显著相关(p结论:IVC过滤器钩嵌入和支架穿透是陷阱钳取出失败的预测因素。术中从陷阱钳到支气管内钳的转换增加了造影剂体积、辐射剂量和总手术时间。当手术前的横断面图像中出现钩嵌入或支杆穿透时,应使用支气管内钳启动IVC过滤器检索。证据等级:三级,大型多中心回顾性队列研究。
Predictors of endobronchial forceps utilization for inferior vena cava filter retrieval: when snare retrieval fails.
Background: Endobronchial forceps are commonly used for complex IVC filter removal and after initial attempts at IVC filter retrieval with a snare have failed. Currently, there are no clear guidelines to help distinguish cases where primary removal should be attempted with standard snare technique or whether attempts at removal should directly be started with forceps. This study is aimed to identify clinical and imaging predictors of snare failure which necessitate conversion to endobronchial forceps.
Methods: Retrospective analysis of 543 patients who underwent IVC filter retrievals were performed at three large quaternary care centers from Jan 2015 to Jan 2022. Patient demographics and IVC filter characteristics on cross-sectional images (degree of tilt, hook embedment, and strut penetration, etc.) were reviewed. Binary multivariate logistic regression was used to identify predictors of IVC filter retrieval where snare retrieval would fail.
Results: Thirty seven percent of the patients (n = 203) necessitated utilization of endobronchial forceps. IVC filter hook embedment (OR:4.55; 95%CI: 1.74-11.87; p = 0.002) and strut penetration (OR: 56.46; 95% CI 20.2-157.7; p = 0.001) were predictors of snare failure. In contrast, total dwell time, BMI, and degree of filter tilt were not associated with snare failure. Intraprocedural conversion from snare to endobronchial forceps was significantly associated with increased contrast volume, radiation dose, and total procedure times (p < 0.05).
Conclusion: IVC filter hook embedment and strut penetration were predictors of snare retrieval failure. Intraprocedural conversion from snare to endobronchial forceps increased contrast volume, radiation dose, and total procedure time. When either hook embedment or strut penetration is present on pre-procedural cross-sectional images, IVC filter retrieval should be initiated using endobronchial forceps.
Level of evidence: Level 3, large multicenter retrospective cohort.