AJR 2005; 185:555-556
© American Roentgen Ray Society
Bird's Nest Filter Migration to the Right Atrium
John O. F. Roehm, Jr.
The Methodist Hospital Houston, TX 77030
The article by Urena and Greenwood
[1] in the October issue of the
American Journal of Roentgenology was of special interest to me as
one of the originators of the Bird's Nest Filter (BNF)
[2]. I placed the first BNF in
1982, and multiinstitutional investigation began in 1984. Since 1984, we have
placed 3,532 BNFs at our institution, and I recently completed review of my
charts of the first 3,000 patients. Our only migration was in 1986, patient
113. That incident led to replacement of the 0.25-mm wire struts with heavier
duty 0.46-mm struts. [3]. As
nicely illustrated by Drs. Urena and Greenwood's case, migration to the heart,
although rare, can have serious consequences. At least according to two
reports, migrations of filters to the pulmonary artery have seemed less
dangerous [4,
5].
In the illustration in the article by Urena and Greenwood
[1], the upper hooks do not
appear to be ideally positioned; added manipulation might have proven
beneficial. As a technical note, unlike "push and pop" filters,
the BNF is under complete operator control until the second pair of hooks has
been released. Before pushing in the wires of the Bird's Nest, rotation of the
catheter and sheath from side to side will often produce a wider separation of
the struts and hooks for more secure engagement of the inferior vena cava
(IVC) wall. If deemed necessary, the first pair of hooks and the nest of wires
can be repositioned within the catheter by advancing the catheter over the BNF
while holding the pusher wire stationary or by merely pulling back on the
pusher wire. Until the second hooks have been released, the unit can be
repositioned, redeployed, or even completely removed. After deploying the
second hook pair, similar twisting of the catheter and sheath and, at times,
advancing the catheter back up the pusher wire before final release, will
improve the spread of the second hooks. These maneuvers should be routine if
there is any question about maximal separation of the struts and hooks.
A brief summary of the findings in the 3,000 cases I reviewed showed the
following: migration, 1 (0.03%); IVC/BNF occlusion, 53 (1.77%); new pulmonary
emboli, 24 (0.8%); suprarenal placement, 54 (1.8%); two filters (mostly BNF
added to preexisting Greenfield filter), 25 (0.83%); preexisting IVC thrombus,
107 (3.57%); teenagers, 16 (0.53%); IVC anomalies, 5 (0.17%); complications, 8
(0.27%). The age range of the patients was 15–96 years.
These results of the use of the BNF over a 20-year interval support its
effectiveness and safety.
References
- Urena R, Greenwood L. Bird's nest filter migration to the right
atrium. AJR 2004;183
:1037
–1039[Free Full Text]
- Roehm JO Jr, Gianturco C, Barth MH, Wright KC. Percutaneous
transcatheter filter for the inferior vena cava: a new device for the
treatment of patients with pulmonary embolism.
Radiology 1984;150
: 255–257[Abstract/Free Full Text]
- Roehm JO Jr, Johnsrude IS, Barth MH, Gianturco C. The bird's nest
inferior vena cava filter: progress report. Radiology1988; 168:745
–749[Abstract/Free Full Text]
- Friedell ML, Goldenkranz RJ, Parsonnet V, et al. Migration of a
Greenfield filter to the pulmonary artery: a case report. Vasc
Surg 1986; 3:929
–931
- Gelbfish GA, Ascer E. Intracardiac and intrapulmonary Greenfield
filters: a long term follow-up. J Vasc Surg1991; 14:614
–617[CrossRef][Medline]
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