SAN DIEGO, CA USA (UroToday.com) - Intra-operative tumor or bland thrombus embolism is a real concern in patients undergoing renal surgery with IVC thrombectomy and can result in mortality or significant morbidity. Dr. Takafumi Yagisawa and colleagues describe potential utility of a temporary intra-operative placement of an IVC filter.
The investigators retrospectively evaluated 25 patients who underwent IVC thrombectomy with use of a flexible, temporary filter system (Neuhause Protect®, Toray Medical, Tokyo, Japan), placed percutaneously via the jugular vein one day prior to the surgical intervention and removed intra-operatively after completion of the procedure. Use of anticoagulation was not employed. Trans-esophageal echocardiogram (TEE) was used for intra-operative thrombus monitoring and if fragmentation was detected on TEE, or by the surgeon, the event was classified as an intra-operative PE (iPE). This group was compared to 29 patients who underwent IVC thrombectomy without the temporary filter.
Three (10.3%) patients in the non-filter group experienced an iPE, none of which resulted in mortality. In those with the temporary IVC filter, 2 patients (8.0%) were noted to have tumor tissue in the filter, which prevented its percutaneous removal and required a cavotomy for retrieval. No complications due to filter placement or removal were observed. Authors conclude that the temporary IVC filter may be effective in preventing iPE. Further evaluation of safety and efficacy is required.
Presented by Takafumi Yagisawa, Tsunenori Kondo, Kazuhiko Yoshida, Kenji Omae, Toshio Takagi, Junpei Iizuka, Hirohito Kobayashi, Yasunobu Hashimoto, and Kazunari Tanabe at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Serge Ginzburg, MD