Retrieval rates of inferior vena cava (IVC) filters: are we retrieving enough?

AIM: The aim of this study was to document retrieval rates of IVC filters in a single tertiary centre, before and after implementation of an IVC filter pathway, and to identify factors that may affect retrieval rates. METHOD: This was a two phase study. In Phase 1, rates of IVC filter retrieval were collected retrospectively from June 2010 to June 2012. During Phase 2 an IVC filter pathway was developed and prospective data was collected from July 2012 to June 2014. Univariate analysis and Kaplan-Meier estimates were performed to determine the rate of IVC filter retrieval and to analyse factors contributing to retrieval rates. RESULTS: 95 patients (39 Phase 1; 56 Phase 2) had an IVC filter inserted over a 4 year period. In Phase 1, of those eligible to have their filter removed, the 12-month retrieval rate was 63%, this improved to 100% in Phase 2. Following implementation of the IVC filter pathway (Phase 2) no patients were lost to follow-up. CONCLUSION: We have improved the rate of IVC filter retrieval in our institution by development of an IVC filter pathway. Rates of optional IVC filter retrieval in our experience are now higher than previously published figures.

Surgical management of extracranial carotid artery aneurysms.

Extracranial carotid artery aneurysms are uncommon and not much is known about them. The purpose of this study is to report the authors' surgical experience and present a review of this entity. This single institution experience shows that resection of these aneurysms and restoration of flow can be accomplished using a number of surgical techniques with relatively low morbidity and mortality. Endovascular techniques are also increasingly being considered in the repair of these aneurysms, although long-term data from such techniques are not currently available.

Endoluminal repair of abdominal aortic aneurysm: the Middlemore Hospital experience.

INTRODUCTION: With endoluminal stent graft (ESG) repair of abdominal aortic aneurysms (AAA) becoming more common, the morphological boundaries are constantly being pushed in deciding which patients to offer this mode of surgical management. In our tertiary hospital we have a relatively strict morphological selection as well as a multidisciplinary team that provides a good platform for performing endoluminal AAA repair. METHOD: A retrospective audit of patients undergoing elective endoluminal AAA repair at Middlemore Hospital (Otahuhu, Auckland, New Zealand) between 1999 and 2005 was performed; 40 patients were identified during this period and all records were reviewed. Prior to surgery, all patients had CT aortography with 3D-reconstruction, and each case was discussed at a multidisciplinary team meeting (vascular surgeons and interventional radiologists present). Patients less than 65 years of age were excluded from this endoluminal assessment. A strict morphological selection criteria was applied and adhered to. RESULTS: Forty patients underwent elective endoluminal AAA repair between 1999 and 2005--5:1 male:female ratio and mean age 73.4 years. Fifty percent of patients had a history of ischaemic heart disease, 48% had known hypertension, 33% had known pulmonary disease, 12% had known diabetes mellitus, while a previous stroke, chronic renal failure, and current smokers respectively accounted for 18%. The American Society of Anaesthesiology (ASA) classification was used to assess patient fitness for surgery. Eighty percent of patients in this study had an ASA of III, 15% had an ASA of II, and the remaining patients had an ASA of IV. These figures are similar to Australian audit data (audit undertaken by ASERNIP-S). Morphology AAA showed mean diameter AAA of 5.2 cm (4.3?6.7 cm). Most AAA were fusiform (fusiform 90% vs saccular 10%). All grafts were of Zenith Cook type bifurcated grafts. There were 2 endoleaks (5%)--type II endoleaks that were sealed with endovascular therapy; 2 patients returned to theatre for embolic complications with good postoperative result; and 1 patient died due to myocardial infarction (MI) postprocedure (mortality 2.5%). Primary technical success was 95% and secondary technical success 100%. There were no conversions to open surgery and no procedural-related deaths. CONCLUSION: This audit from Middlemore Hospital shows good results can be achieved using strict morphological selection criteria and a multidisciplinary approach to treatment for ESG of AAA.