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.

Houston Methodist Ruptured Abdominal Aortic Aneurysm Guidelines.

Ruptured abdominal aortic aneurysm (RAAA) is an acute aortic condition that requires emergent intervention and appropriate continuity of care to optimize patient outcomes. We describe the standardized RAAA protocol at the Houston Methodist Hospital Acute Aortic Treatment Center, developed to navigate critical patient transfer periods safely and efficiently, make crucial decisions about surgical intervention, and clearly communicate these plans with other care team providers. Our workflow is organized into five phases: prehospital, preoperative, intraoperative, postoperative, and post-discharge. We identify the transfer center, anesthesia, operating room nursing staff, surgeons, and intensive care unit as key entities of our acute aortic pathology care team. This systematic protocol for the management of acute aortic emergencies such as RAAA identifies critical decision points, potential complications at each stage, and recommendations for best practice.