Evolving Landscape of Inferior Vena Cava Filter Utilization: A Comprehensive Bibliometric Analysis.

This bibliometric analysis scrutinizes the evolution and current challenges in the use of Inferior Vena Cava (IVC) filters, focusing on trends from 2004 to 2023. Analyzing 2470 records, we report the United States' dominant role, with over half of the studies, and a significant shift towards retrievable filters. Despite technological advancements, controversies persist regarding efficacy, safety, and retrieval issues. Our findings point to the need for refined clinical guidelines and enhanced management strategies to navigate the complex landscape of IVC filter utilization effectively.

A porcine model of thoracic aortic aneurysms created with a retrievable drug infusion stent graft mirrors human aneurysm pathophysiology.

Objective: Aneurysm pathophysiology remains poorly understood, in part from the disparity of murine models with human physiology and the requirement for invasive aortic exposure to apply agents used to create aneurysm models. A retrievable drug infusion stent graft (RDIS) was developed to isolate the aortic wall intraluminally for drug exposure. We hypothesized that an RDIS could deliver aneurysm-promoting enzymes to create a porcine model of thoracic aneurysms without major surgical exposure. Methods: Retrievable nitinol stent graft frames were designed with an isolated drug delivery chamber, covered with polytetrafluoroethylene, and connected to a delivery wire with a drug infusion catheter installed to the outer chamber. Institutional Animal Care and Use Committee-approved Yorkshire pigs (n = 5) underwent percutaneous access of the femoral artery, baseline aortogram and stent placement in the thoracic aorta followed by 30-minute exposure to a cocktail of elastase, collagenase, and trypsin. After aspiration of excess drug, stent retrieval, and femoral artery repair, animals were recovered, with angiograms at 1 and 4 weeks followed by explant. Histological analysis, in situ zymography, and multiplex cytokine assays were performed. Results: The RDIS isolated a segment of anterior aorta angiographically, while the center lumen preserved distal perfusion during drug treatment (baseline femoral mean arterial pressure, 70 ± 14 mm Hg; after RDIS, 75 ± 12; P = .55). Endovascular induction of thoracic aneurysms did not require prior mechanical injury and animals revealed no evidence of toxicity. Within 1 week, significant aneurysmal growth was observed in all five animals (1.4 ± 0.1 cm baseline to 2.9 ± 0.7 cm; P = .002) and only within the treated region of the aorta. Aneurysms persisted out to 4 weeks. Aneurysm histology demonstrated loss of elastin and collagen that was otherwise preserved in untreated aorta. Proinflammatory cytokines and increased matrix metalloproteinase activity were increased significantly within the aneurysm. Conclusions: An RDIS achieves isolated drug delivery while preserving distal perfusion to achieve an endovascular porcine model of thoracic aneurysms without major surgery. This model may have value for surgical training, device testing, and to better understand aneurysm pathogenesis. Most important, although the RDIS was used to simulate aortic pathology, this tool offers intriguing horizons for focused therapeutic drug delivery directly to aneurysms and, more broadly, focused locoregional drug delivery to vessels and vascular beds.

Screw-retrievable cement-retained implant restorations: A scoping review of fracture strength and clinical performance.

BACKGROUND: The screw-retrievable cement-retained (SRCR) design combines the benefits of both screwand cement-retained implant-supported restorations. This concept has sparked interest in implant dentistry. However, there is a lack of research on fracture behaviors and clinical performance of such restorations. OBJECTIVES: The aim of the present article was to review the current literature on the fracture loads and fracture modes of SRCR implant restorations - in vitro studies, and also studies demonstrating the clinical performance of such design. MATERIAL AND METHODS: A literature search was conducted from January 2000 to June 2022, using 6 databases to identify studies on fracture load and clinical performance that fulfilled the eligibility criteria. Thirty-eight studies met the inclusion criteria (22 in vitro and16 in vivo). The in vivo studies comprised case reports/series/letters (9), clinical techniques (2), retrospective/prospective studies (3), and randomized controlled trials (RCTs) (2). RESULTS: The reviewed articles reported the effects of the SRCR design on the fracture risk if screw access channels were filled or unfilled, with regard to their diameter, and the preparation before or after glazing. The effect of the type of material used in the construction on the fracture modes SRCR restorations was also reported. The long-term clinical data was mainly retrospective and referred to metal-ceramic constructions. Limited long-term clinical data was available for all-ceramic materials and high-performance polymers (HPPs). CONCLUSIONS: Screw-retrievable cement-retained implant restorations appear to have potential in the monolithic design. If the SRCR construction is metal-ceramic or made of a veneered material, special design and abutment selection should be considered. High-performance polymers may be recommended as a substitute for posterior implant restoration.

Percutaneous placement of a retrievable fully covered metal stent with anchoring flaps for the treatment of biliary anastomotic stricture following LDLT.

To investigate the outcomes following percutaneous placement of a retrievable fully covered self-expanding metal stent (fcSEMS) with anchoring flaps at proximal and distal ends for the treatment of biliary anastomotic strictures following living-donor liver transplantation (LDLT). We retrospectively reviewed the medical records of nine patients who underwent this procedure at our centre between April 2020 and March 2021. Percutaneous stent placement was technically successful in 100% patients, and all stents were successfully retrieved. No proximal or distal stent migration or occlusion was observed during the mean (±SD) stent indwelling period of 191(± 77) days. Clinical success was 89%. There was one major bleeding complication related to the biliary approach and one minor stent-related complication of calculus/sludge. During the mean (±SD) follow-up period of 595 ± 207 days after stent retrieval, only one patient developed recurrent clinical biliary stricture and symptoms. Percutaneous placement of a retrievable fcSEMS with anchoring flaps is safe and feasible for the treatment of biliary anastomotic strictures following LDLT.

Different leadless pacemakers working in harmony (Aveir in the atrium/Micra AV2 in the ventricle) in a patient with dextrocardia and double outlet right ventricle after high-risk infected device extraction.

INTRODUCTION: Patients with congenital heart disease are at increased risk for requiring cardiac pacing during their lifetime. METHODS: We present the first described case of using two leadless pacing systems manufactured by separate companies implanted within the same patient to provide atrial and ventricular pacing due to complex congenital anatomy. RESULTS: A 27-year-old male with dextrocardia with double outlet right ventricle, subaortic ventricular septal defect, and pulmonary stenosis status-post pulmonary valve replacement complicated by ventricular pacing dependence and subsequent atrial pacing dependence after atriotomy-based atypical flutter ablation developed recurrent mediastinitis and pocket infection with erosion despite prolonged antibiotic treatment. Due to atrial and ventricular pacing dependence, a comprehensive congenital care team concluded the need for lead extraction and replacement of pacemaker via leadless peacemaking device. Laser-lead extraction and temporary atrial pacemaker placement was performed. Afterward, a transesophageal echocardiogram guided implantation of both a Micra AV 2 (Medtronic) leadless pacemaker in the interventricular septum within the right ventricle and an Aveir (Abbott) leadless pacemaker in the superior base of the right atrial appendage was performed with successful pacing. Although there is no communication between these devices, atrial-mechanical ventricular pacing was reliable with good implant thresholds, impedances and sensing from both devices. CONCLUSION: Our case demonstrates the feasibility of using dual leadless pacing modalities to simultaneously pace someone at complex, prohibitive risk for temporary permanent or permanent pacemaker devices.

Construction of a floating photothermal-assisted photocatalytic system with a three-dimensional hollow porous network structure.

Solar energy is the inevitable choice to achieve the low-carbon, green, and circular development of society, and photocatalysis technology is one of the shining pearls. To make full use of the solar spectrum and solve the shortcomings of the recovery difficulty of powdery materials and the loss of activity due to the influence of the external environment, it is possible to construct floating materials using melamine sponges to recover photocatalytic materials quickly. At the same time, floating materials can absorb oxygen in the air for the generation of active groups, effectively solving the problem of less O2 in the water. The carbon-based materials have excellent light absorption properties, high thermal conductivity, and excellent photothermal conversion efficiency and are ideal for constructing floating photothermal photocatalytic systems. As an example, we combined a cheap melamine sponge with urea, prepared a hollow porous network structure g-C3N4 (HPNCN) with a high specific surface area by direct thermal shrinkage method, and then attached the CoO to its surface by hydrothermal method to form a heterojunction with a suitable band gap. Various characterization tests verified the photothermal-photocatalytic properties. Among them, 30% CoO/HPNCN has the best photocatalytic degradation effect on tetracycline (TC), and the removal rate is 88.1%. After five cycles, the removal rate is only 5% lower than the initial, indicating that it has good stability and recyclability. We conducted an active ingredient capture experiment, ESR, and LC-MS analysis to clarify the intermediates and reaction mechanism of TC photocatalytic degradation. On this basis, the ECOSAR program and QSAR method were used to analyze the environmental toxicity of TC and its intermediate products. These results provide a broad prospect for the potential application of the floating photothermal-photocatalysis system in antibiotic pollution control and its application in other fields.

Endoscopic ultrasound guided gastroenterostomy: Technical details updates, clinical outcomes, and adverse events.

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has been transformed from an innovative technique, into a viable alternative to enteral stenting and surgical gastrointestinal anastomosis for patients with gastric outlet obstruction. Even EUS-GE guided ERCP and EUS-guided gastrointestinal anastomosis for the treatment of afferent loop syndrome have been performed, giving patients more less invasive options. However, EUS-GE is still a technically challenging procedure. In order to improve EUS-GE, several techniques have been reported to improve the technical details. With EUS-GE widely performed, more data about EUS-GE's clinical outcomes have been reported. The aim of the current review is to describe technical details updates, clinical outcomes, and adverse events of EUS-GE.

Endovascular retrieval of a fractured Optease inferior vena cava filter using endobronchial forceps and intraoperative cone-beam computed tomography guidance.

Endovascular retrieval of fractured inferior vena cava (IVC) filters after the manufacturer recommended indwelling time can be challenging and require advanced retrieval techniques. We describe an endovascular retrieval technique of a fractured Optease IVC filter in a 57-year-old woman using endobronchial forceps and intraoperative cone-beam computed tomography guidance. Following incomplete filter retrieval, the location and orientation of fractured strut was confirmed by cone-beam computed tomography venography. The embedded filter fragment was then successfully removed using endobronchial forceps via a transjugular venous approach. In the present report, we highlight the additional value of intraoperative cross-sectional imaging, in conjunction with advanced endovascular techniques, for retrieval of challenging IVC filters.

Inferior Vena Cava Filters and Complications: A Systematic Review.

Inferior vena cava (IVC) filters have been used since the 1960s to treat patients with acute risk of pulmonary embolism (PE) to prevent migration of thrombus by trapping it within the filter. Traditional usage has been in patients with contraindication to anticoagulation that carry a significant mortality risk. In this systematic review, we sought to evaluate complications associated with placement of inferior vena cava filters based on published data from the past 20 years. A search was performed on October 6th, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews, using three databases (ProQuest, PubMed and ScienceDirect) for articles published between the dates of February 1, 2002 and October 1, 2022. Results were filtered to include full-text, clinical studies, and randomized trials written in English pertaining to keywords "IVC filter AND complications", "Inferior Vena Cava Filter AND complications", "IVC filter AND thrombosis" and "Inferior Vena Cava Filter AND thrombosis". Articles identified by the three databases were pooled and further screened for relevance based on inclusion and exclusion criteria. Initial search results yielded 33,265 hits from all three databases combined. Screening criteria were applied, with 7721 results remaining. After further manual screening, including removal of duplicate hits, a total of 117 articles were selected for review. While there are no consensus guidelines for best practice, there is compelling evidence that IVC filters can provide significant protection against PE with minimal complications if the treatment window is appropriate. Increase in the variety of filter models has led to broader availability, but skepticism remains about their efficacy and safety, with ongoing controversy surrounding appropriate indications. Further research is needed to establish clear guidelines on appropriate indications for IVC placement and to determine time course of complications versus benefits for indwelling filters.

A multifunctional recyclable adsorbent based on engineered MIL-125 (Ti) magnetic mesoporous composite for the effective removal of pathogens.

The elimination of pathogenic bacteria from water sources is currently crucial for obtaining drinkable water. Therefore, the development of platforms with the ability to interact with pathogens and remove them is a potential future tool for medicine, food and water safety. In this work, we have grafted a layer of NH2-MIL-125 (Ti) on Fe3O4@SiO2 magnetic nanospheres for the removal of multiple pathogenic bacteria from water. The synthesized Fe3O4@SiO2@NH2-MIL-125 (Ti) nano adsorbent was characterized by FE-SEM, HR-TEM, FT-IR, XRD, BET surface analysis, magnetization tests, respectively, which illustrated its well-defined core-shell structure and magnetic behaviour. The prepared magnetic-MOF composite sorbent was attractive towards capturing a wide range of pathogens (S. typhimurium, S. aureus, E. coli, P. aeruginosa and K. pneumoniae) under experimental conditions. Influence factors such as adsorbent dosage, bacterial concentration, pH and incubation time were optimized for enhanced bacterial capture. The application of an external magnetic field removed Fe3O4@SiO2@NH2-MIL-125 (Ti) nano adsorbent from the solution along with sweeping the attached pathogenic bacteria. The non-specific removal efficiency of S. typhimurium for magnetic MOF composite was 96.58%, while it was only 46.81% with Fe3O4@SiO2 particles. For specific removal, 97.58% of S. typhimurium could be removed selectively from a mixture with monoclonal anti- Salmonella antibody conjugated magnetic MOF at a lower concentration of 1.0 mg/mL. The developed nano adsorbent may find great potential in microbiology applications and water remediation.

The effect of different frames filters on the prevention of pulmonary embolism in fracture patients subsequent with deep venous thrombosis on a multicenter prospective observational study.

BACKGROUND: A retrievable inferior vena cava filter (RIVCF) is used for the prevention of a pulmonary embolism, especially originated from deep venous thrombosis (DVT). However, which frame of RIVCF has an better effect on the specific thrombus has not been reported. METHODS: All patients enrolled underwent RIVCF placement in the study, and the placement and retrieval followed the respective instructions of different brands of RIVCFs. During the study period, the frame of the filter, the combined fracture site and operation, and the filter trapped embolus (TE) were collected. The primary observation indicators of this study were the occurrence of TE in two frames of filters and different fracture sites. Secondary observation indicators were the occurrence of TE with two different frames filters in different fracture site and surgical site subgroups. RESULTS: In all 2892 patients enrolled, RIVCF TE was detected in 308 cases (10.7%) according to our definition. Among them, there were 1968 cases of fusiform RIVCF and 924 cases of umbrella RIVCF. There were 663 patients combined with fractures before DVT. The incidence of TE was significantly higher in patients with fusiform RIVCF (230 [74.68%]) than in those with umbrella RIVCF (78 [25.32%]) (P < .05). In patients with below-the-knee fracture surgery, there was significant difference in the incidence of TE between the two frames of RIVCF (P < .05). CONCLUSIONS: This conclusion suggests that, in patients with DVT secondary to below-the-knee fracture, the detached thrombus may be more suitable for prophylaxis with fusiform frame RIVCF.

Inferior Vena Cava Filter Use in the Setting of Gastrointestinal Blood Loss, Malignancy, and Multiple Thromboembolisms: A Case Report.

Cancer-associated thromboembolism (CAT) is a common yet serious condition that occurs due to the physiological changes brought about by malignancy. The two conditions that are the most prevalent are deep vein thrombosis (DVT) and pulmonary embolism (PE). Anticoagulation is the standard of care for these thrombotic problems, however, in the event these medications are contraindicated, other treatment modalities may be needed. One common example is in the setting of an active bleed, such as gastrointestinal (GI) cancer. A treatment that has been used more frequently in recent years is the inferior vena cava (IVC) filter. These can be placed to provide a physical barrier to prevent a thrombus from moving through the circulation and potentially embolizing critical organs. An advantage of these devices is that they can be placed and removed when the use of pharmacological agents is better indicated. This report is a good example of a situation where an active GI malignancy created a hypercoagulable state leading to multiple thromboembolisms. An IVC filter was placed in the perioperative setting to prevent further thrombus migration while the primary malignancy was cured with a hemicolectomy.

Percutaneous Transhepatic Treatment of Benign Bile Duct Strictures Using Retrievable Covered Stents: Long-Term Outcomes in 148 Patients.

OBJECTIVE: To investigate the long-term outcomes of percutaneous treatment of benign biliary strictures using temporary placement of a retrievable expanded polytetrafluoroethylene (PTFE) covered stent. MATERIALS AND METHODS: We retrospectively analyzed the outcomes of 148 patients (84 male and 64 female; age range, 11-92 years) who underwent percutaneous transhepatic placement and removal of a retrievable PTFE-covered stent for the treatment of benign biliary strictures between March 2007 and August 2019 through long-term follow-up. Ninety-two patients had treatment-naïve strictures and 56 had recurrent/refractory strictures. RESULTS: Stent placement was technically successful in all 148 patients. The mean indwelling period of the stent was 2.4 months (median period, 2.3 months; range, 0.2-7.7 months). Stent migration, either early or late, occurred in 28 (18.9%) patients. Clinical success, defined as resolution of stricture after completing stent placement and removal, was achieved in 94.2% (131 of 139 patients). The overall complication rate was 15.5% (23 of 148 patients). During the mean follow-up of 60.2 months (median period, 52.7 months; range, 1.6-146.1 months), 37 patients had a recurrence of clinically significant strictures at 0.5-124.5 months after removal of biliary stent and catheter (median, 16.1 months). The primary patency rates at 1, 3, 5, 7, and 10 years after removal of biliary stent and catheter were 88.2%, 70.0%, 66.2%, 60.5%, and 54.5%, respectively. In the multivariable Cox proportional hazard regression analysis, sex, age, underlying disease, relation to surgery, stricture type, biliary stones, history of previous treatment, and stricture site were not significantly associated with the primary patency. CONCLUSION: Long-term outcomes suggest that percutaneous treatment of benign biliary strictures using temporary placement of retrievable PTFE-covered stents may be a clinically effective method.

Pathological Analysis and Clinical Evolution After Radiological Removal of Retrievable Vena Cava Filters.

OBJECTIVE: Retrievable inferior vena cava filters (IVCF) have been developed because permanent filters have been associated with an increased risk of recurrent deep venous thrombosis. There is no data on the interactions of IVCF with the inferior vena cava (intrafilter thrombi, insertion through the venous wall) even though this may alter the course after retrieval of the IVCF. METHODS: A review of 85 consecutive patients undergoing retrieval of IVCF placed at a single center was performed from January 1, 2010 and December 31, 2014. Inferior vena cava filter were examined for presence of intrafilter thrombus at time of retrieval. Filter position and presence of intraluminal thrombus were examined. Patient outcomes, including recurrence of deep vein thrombosis (DVT) and death, were captured at 3 month followup. RESULTS: Eighty five patients were identified, with intrafilter thrombi found in 69 (81%) patients and venous wall fragments found in 75 (88%) patients. However, their presence was not associated with an increased risk of recurrent venous thromboembolism (VTE) or death during follow up. CONCLUSIONS: Intrafilter thrombi and venous wall fragments are frequently found in removed IVCF but are not associated with a worse prognosis. They may not modify the therapeutic management of patients.

3D Printing Mini-Capsule Device for Islet Delivery to Treat Type 1 Diabetes.

Transplantation of encapsulated islets has been shown to hold a promising potential treatment for type 1 diabetes (T1D). However, there are several obstacles to overcome, such as immune rejection by the host of the grafts, sustainability of islet function, and retrievability or replacement of the encapsulated system, hinder their clinical applications. In this study, mini-capsule devices containing islets were fabricated by using digital light processing (DLP) 3D printing. To ensure a high survival rate and low immunogenicity of the fabricated islets, 20s was selected as the most suitable printing condition. Meanwhile, the mini-capsule devices with a groove structure were fabricated to prevent islet cells leakage. Subcutaneous transplantations of encapsulated islets in immunocompetent C57BL/6 mice indicated significant improvement in the symptoms of streptozotocin-induced hyperglycemia without any immunosuppression treatment for at least 15 weeks. In vivo intraperitoneal glucose tolerance tests (IPGTT) performed at different time points demonstrated therapeutically relevant glycemic ameliorate of the device. The implants retrieved after 15 weeks still contained viable and adequate numbers of islet cells. The results of this study indicate that the proposed mini-capsule device can deliver sufficient islet cell mass, prevent islet cells leakage, and maintain long-term cell survival while allowing easy retrieval. Furthermore, the proposed encapsulated islets may help with T1D cellular treatment by overcoming the obstacles of islet transplantation.

Recurrent Cardiac Arrests Due to Amniotic Fluid Embolism.

Amniotic fluid embolism (AFE) is a rare but devastating complication of pregnancy and is associated with high morbidity and mortality. Identifiable maternal risk factors for AFE include older age, multiparity, cesarean section, and placenta previa, while fetal factors include male gender, fetal distress, and death. AFE presents with respiratory distress, seizure, and circulatory collapse and can be complicated with disseminated intravascular coagulopathy, multiorgan failure, and death. In our case, we present a patient who underwent elective cesarean section for placenta previa, which was complicated by sudden cardiac arrest immediately after delivering the placenta in the operating theatre followed by disseminated intravascular coagulation (DIC). The patient developed massive post-partum hemorrhage secondary to the underlying DIC, which required a massive blood transfusion along with platelets, fresh frozen plasma (FFP), and tranexamic acid. The Society of Maternal-Fetal Medicine proposed criteria for the diagnosis of AFE, which include clinical features and laboratory findings. The presence of a DIC picture is considered to be the hallmark finding that helps to differentiate between AFE and other conditions with similar presentation. Treatment of amniotic fluid embolism depends on early recognition and supportive care.

Anti-coagulation and anti-hyperplasia coating for retrievable vena cava filters by electrospraying and their performance in vivo.

A novel drug eluting retrievable vena cava filter (RVCF) with a heparin-modified poly(ε-caprolactone) (hPCL) coating containing rapamycin was prepared by electrospraying. The in vitro drug release pattern showed that the encapsulated rapamycin in the coating can be sustainably released within one month, whereas activated partial thromboplastin time (APTT) and in vitro cell culture showed that the drug eluting RVCF can effectively extend blood clotting time and inhibit smooth muscle cell (SMC) and endothelial cell (EC) proliferation, respectively. The as-prepared drug eluting RVCF and corresponding commercial RVCF were implanted into the vena cava of sheep. The retrieval operation at a predetermined time point showed that the drug eluting RVCF had a much higher retrieval rate than the commercial RVCF. Comprehensive investigations, including histological, immunohistological and immunofluorescence analyses, on explanted veins were carried out. The results demonstrated that the as-prepared RVCF possessed excellent antihyperplasia properties in vivo, significantly improving the retrieval rate and extending the in vivo dwelling time in sheep. Consequently, the drug eluting RVCF has promising potential for application in the clinic to improve RVCF retrieval rates.

Clinical outcomes of retrievable inferior vena cava filters for venous thromboembolic diseases.

Aim: To identify literature evidence assessing retrievable inferior vena cava filter (rIVCF) for venous thromboembolic diseases. Methods: A systematic literature search was conducted to identify relevant references from the mainstay English and Chinese bibliographic databases (search period: January 2003 to October 2019). Results: 80 original studies with 11,413 patients were included in this review. The success rates of deploying the six types of rIVCFs ranged from 98.4 to 100.0%. Denali had the highest retrieval success rate (95.4-97.6%). The incidence rates of fracture and perforation associated with retrieving the six rIVCFs were less than 2%. Conclusion: The approved rIVCF had comparable clinical profiles, except that Denali was easier to be retrieved than other rIVCF.

An expert spotlight on inferior vena cava filters.

Introduction: Inferior vena cava (IVC) filters are mechanical filtration devices designed as an alternative to surgical ligation/plication of the IVC. Their use has been controversial, especially with the introduction of retrievable filters and expanded/prophylactic indications.Areas covered: Authors discuss the types of available IVC filters, indications for placement, evidence on their effectiveness in general and specific patient populations, procedural considerations, off-label use, complications, and filter retrieval. This review is based on manuscripts/abstracts published from 1960 to 2021 on venous thromboembolism and IVC filters.Expert opinion: Despite the limited data on their effectiveness and survival benefit, IVC filters continue to play an important role in the treatment of patients with venous thromboembolism (VTE) who cannot receive standard anticoagulation. There is no role of IVC filters in patients without VTE. While retrievable filters are desirable for short-term use, a dedicated team-based approach, and advanced training are required for their successful removal. Newer devices are promising in improving patient safety . The device manufacturers and regulatory agencies should consider specific approaches to track device-related adverse events. Population-based studies are required to establish optimal patient population who would benefit from these devices. .