Case repor t for Capturex ® Retr ievab le Infer ior Vena Cava ( IVC) f i l te r

I . Rutkauskas, prof. M. J ieva ltas, assoc. prof. L . Ve l i čka.

Introduct ion: Cancer is a well-known risk factor for developing Venous Thromboembolism (VTE). Temporary filters (i.e. filters

that have the “option” of being retrieved) have been available since the late 1990‘s and are designed to be

retrieved or left in place after the temporary risk of PE or contraindication to anticoagulation has resolved

[1]. Temporary filters might be placed for prophylactic indications in patients who are at increased risk for the

development of VTE such as in the trauma setting or during the high VTE risk operation [2;3].

Venous migration and tumor thrombus formation are unique aspects of renal cell carcinoma (RCC) [4]. Patients

diagnosed with RCC have involvement of the inferior vena cava (IVC) in up to 35% of cases [5]; specifically

thrombosis has been reported to occur in 4%–10% of patients with renal neoplasms. [6] Within this group,

2%–16% have tumors extending into the right atrium [7]. The level of tumor thrombus in the IVC does not

significantly affect long-term survival [8]. Once a future perspective, now commonly available retrievable IVC

filters are chosen for complicated clinical cases [9]. In July 201 3 Straub Medical (Wangs, Switzerland) announced

the commercial launch of the CE Mark-approved Capturex® vascular protection system in selected European

markets. Capturex® is indicated for the prevention of massive thrombus embolization during embolizing-

potential endovascular procedures [10]. Data from 2018 supports the effectiveness of preoperative temporary

IVC placement to prevent thrombo-embolism and to improve surgical safety [11]. The Capturex® vascular

protection system may offer a safe and effective protection device during removal of thrombosed IVC filters or

during mechanical thrombectomy [12].

Descr ipt ion of Case 74 years old male with fatigue and back pain, abdominal CT scan demonstrated tumor in the left kidney

(Fig. 1. Arrow No. 1).

Diagnosed with prostate cancer in 20 1 7. Treatment started with hormone therapy, planned to add radiation

therapy. (Ca renis sin. cT3 N0 M0. Ca gl. prostatae). Bioprosthetic aortic valve replacement surgery in 201 8.

Figure 1. CT scan shows tumor in the left kidney.

Figure 2. IVC thrombosis extending up to right atrium.

IVC thrombosis extending up to

right atrium (Fig. 2. Arrow No 2). No

metastasis or other abnormalities were

found in the lungs.

During further medical examination, Cardiac Ultrasound was performed which showed bioprosthetic aortic valve,

with mild - to moderate calcinosis of valvular ring. The diameter of the chambers of the heart were in the normal

range. There was normal systolic function of both left and right ventricles. A mild degree of insufficiency in the

mitral and tricuspid valves was observed . No hypertension in the pulmonary artery was observed. Hematologist

consultation - Anaemia ferodeficitica (evidence for haemolytic anemia is insufficient, no other abnormalities

were observed).

Abdominal Ultrasound right before surgery and angiography - IVC ~7,5 cm thrombus, extending to right atrium,

hepatic veins confluence.

Figure 3. 3. Undeployed IVC filter. 4. Central Venous Catheter. 5. Guidewire inserted in IVC.

Descr ipt ion of Procedure Patient was operated in the hybrid OR on 10/08/2018. First, a right trans jugular approach was made and a

0.018” Guidewire was inserted into the Capturex® (Arrow No 5). An introducer sheath ≥ 10F is required for the

procedure. A pre-deployed IVC filter (Arrow No 3) and Central Venous Catheter, CVC (Arrows No 4) is seen.

Figure 4. 5. Guidewire6. Capturex® Vascular Protection System deployed.

The Capturex® filter was deployed just above the

thrombus at the level of confluence of IVC and right

atrium (Arrows No 5, 6).

Subsequently, using transperitoneal “chevron” laparo-

tomy, a left nephrectomy was performed together with

thrombectomy from the IVC with primary suture of

venotomy. Early postoperative period was complicated

by pneumonia that was cured with cefuroxime.

Capturex® was removed with no evidence of debris on

the struts, indicating that the thrombectomy removed

100 % of the thrombus.

Total hospitalization time - 1 2 days. Patient set off to

rehabilitation full recovery.

References: 1. Systematic review of the use of retrievable inferior vena cava filters. Angel LF, Tapson V, Galgon RE, Restrepo MI, Kaufman J. J Vasc Interv Radiol. 2011 Nov; 22(11):1522-1530.e3.2. Kinney TB. Review Update on inferior vena cava filters. J Vasc Interv Radiol. 2003 Apr; 14(4):425-40.3. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. Rogers FB, Cipolle MD, Velmahos G, Rozycki G, Luchette FA. J Trauma. 2002 Jul; 53(1):142-64.4. Resection of the abdominal inferior vena cava for complicated renal cell carcinoma with tumour thrombus. Ciancio G, Soloway M BJU Int. 2005 Oct; 96(6):815-85. Results of inferior vena cava resection for renal cell carcinoma. Kearney GP, Waters WB, Klein LA, Richie JP, Gittes RF J Urol. 1981 Jun; 125(6):769-736. Renal cell carcinoma with an infrarenal vena caval tumor thrombus. Mootha RK, Butler R, Laucirica R, Scardino PT, Lerner SP. Urology. 1999 Sep; 54(3):561.7. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Nesbitt JC, Soltero ER, Dinney CP, Walsh GL, Schrump DS, Swanson DA, Pisters LL, Willis KD, Putnam JB Jr. Ann Thorac Surg. 1997 Jun; 63(6):1592-600.8. Prognostic Significance of Tumor Thrombus Level in Patients With Renal Cell Carcinoma and Venous Tumor Thrombus Extension. Is All T3b the Same? Moinzadeh, Alireza et al. The Journal of Urology, Volume 171, Issue 2, 598-6019. Nouh MA, Inui M, Kakehi Y. Renal Cell Carcinoma with IVC Thrombi; Current Concepts and Future Perspectives. Clin Med Oncol. 2008;2:247-56.10. Endovascular Today - Straub Medical Launches Capturex® Filter Catheter in European Markets. (2013, July 1). https://evtoday.com/2013/07/01/straub-medical-launches-Capturex®-filter-catheter11. Grasso M, Blanco S, Segramora V, Grasso EC, Leni D, Conti GM. Optional caval filter in kidney cancer patients with tumor thrombus level I and II. Minerva Urol Nefrol 2018;70:74-8. DOI: 10.23736/S0393-2249.17.02867-312. Abstract No. 646 Peri-interventional use of Capturex® filter catheter during removal of thrombosed inferior vena cava filters and venous thrombectomy: preliminary results of a single-institution experience Alharbi, A. et al. Journal of Vascular and Interventional Radiology, Volume 29, Issue 4, S268

Rat ionale for treatment with the Capturex ® Vascular Protect ion System In this clinical case the retrievable Straub Capturex® vascular protection system was chosen because of already

existing, US and CT scan verified, thrombus observed above the level of the renal veins and diaphragm. An open

thrombectomy with left nephrectomy was performed simultaneously.