Which Interventional Radiology Device Review: Celect vena cava filter

Features
This filter is designed for enhanced retrievability and to be less likely to tilt in the cava on deployment.

Design/construction
The filter is constructed from Egiloy which is a cobalt-nickel alloy with good elasticity and strength. The filter differs from the previous Gunther Tulip filter in several ways. The four legs are straighter rather than bowed. The arms or interstices, seen on the Gunther Tulip are no longer attached to the legs. This means the arms extend beyond the radius created by the legs allowing for a more parallel lie in the Cava, as well as straightening qualities that its predecessor did not have. The crossing points between legs and arms of the Gunther Tulip also lead to tethering to the caval wall after prolonged in situ times.

In Use
The filter looks and feels very much like the Cook Gunther Tulip filter. The method of insertion is exactly the same, with either jugular or femoral approaches. The delivery catheters are also unchanged.

Retrieval method is also unchanged, requiring jugular access, and use of the snare and catheter technique. The feel of the filter and radial force are all unchanged.

The small size of the retrieval hook may be problematic after prolonged dwell times, as it may be either coated in neointima or have synechial attachments to caval wall, preventing ensnaring. In fact we have used off label techniques in some 13 retrievals with either over the wire or through and through wire snaring techniques. Like all filters they can still tilt and we have had four that are too endothelialized to retieve.

Results so far
At the Alfred we have now inserted 123 of these filters and retrieved 59, both as part of our normal practice beginning in December 2006 and the Cook Celect trial. The Celect is clearly easier to retrieve than the Gunther Tulip and this has been borne out in the preliminary data.

Dr Stuart M Lyon
Head of Interventional Radiology
The Alfred
Australia
No conflict declared