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Perforation of Inferior Vena Cava Filters

Herbert, Robert
http://rave.ohiolink.edu/etdc/view?acc_num=osu1492694912566491

Abstract Details

2017, Master of Science, Ohio State University, Mechanical Engineering.
Pulmonary embolism (PE) accounts for an estimated 200,000 deaths a year in the U.S. While anticoagulation is the standard treatment, an inferior vena cava filter (IVCF) may be inserted to capture clots travelling towards the lung area when anticoagulation is not an option. Although retrievable IVCFs are approved for permanent use, safety concerns exist that can lead to complicated retrieval procedures, particularly IVCF perforation. Despite these concerns, IVCFs are often not monitored after placement. Therefore, one goal of this study was to determine and investigate the mechanical factors associated with the strut perforation of IVCFs. Furthermore, it aimed to reveal reasoning for the difference in perforation rates among male and female patients and between patients with and without a history of malignancy, as was observed in a former study. The resulting information could be used to discuss follow-up procedures and to determine if finite element modeling may be used to predict perforation. To perform this study, 37 patients indicating perforation with a Celect IVCF were observed, each having at least three computed topography (CT) images after placement of the filter. Three-dimensional (3D) finite element modeling in ADINA was applied to simulate the IVCF at each CT image set. The resulting maximum and average total and normal forces on each strut face were recorded from the simulation and compared to the filter strut perforation in the following CT study. By investigating the role of IVC diameter in combination with patient gender and malignancy history, it was observed that female patients and patients with a history of malignancy were more susceptible to perforation, particularly at lower IVC diameters. However, inconsistent results occurred for these forces in female patients. Secondly, due to the reported difference in perforation rates of the Celect IVCF and Greenfield IVCF, finite element models of both were deformed to simulate placement within a circular IVC. Average total and normal force on the filter feet were calculated and compared at IVC diameters between 1.5 and 3.0 cm. It was determined that the filters had similar total forces at a given diameter, but the Greenfield IVCF indicated significantly lower normal forces. This lower outward force applied to the IVC wall may explain the lower perforation rates of the Greenfield design. Lastly, a fluid-structure interaction (FSI) model was developed in order to investigate additional potential factors of perforation, including blood flow, captured clots, IVC wall stiffness, blood pressure, IVC diameter, and filter tilt. While varying each of these parameters, average IVC wall stress and IVCF foot stresses were recorded to determine the influence on perforation. Sensitivity values were calculated for the tested configurations. Results indicate the IVC diameter and captured clot size dictate the risk of perforation, with smaller IVC diameters and larger clots increasing the risk. Additionally, this risk was amplified as flow rate approached exercise conditions. Lastly, filter tilt altered the distribution of stresses among filter feet, most importantly by increasing the stress at specific feet. All tested parameter combinations had an insignificant impact on normal forces. However, total stress and shear stress were impacted. Thus, recommendations of removing or replacing IVCFs may be influenced by the patient’s IVC diameter and the presence of a captured clot.
Samir Ghadiali (Advisor)
Mark Ruegsegger (Committee Member)
87 p.
Biomedical Engineering; Engineering; Mechanical Engineering
Inferior Vena Cava Filter; Perforation; IVCF; Celect; Greenfield; Vena Cava; Pulmonary Embolism; PE

Recommended Citations

Citations

  • Herbert, R. (2017). Perforation of Inferior Vena Cava Filters [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1492694912566491

    APA Style (7th edition)

  • Herbert, Robert. Perforation of Inferior Vena Cava Filters. 2017. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1492694912566491.

    MLA Style (8th edition)

  • Herbert, Robert. "Perforation of Inferior Vena Cava Filters." Master's thesis, Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1492694912566491

    Chicago Manual of Style (17th edition)

osu1492694912566491
246
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This open access ETD is published by The Ohio State University and OhioLINK.