Cook Medical Guenther Tulip Vena Cava Filter | Used in IVC filter | Which Medical Device

Guenther Tulip Vena Cava Filter

Added Mar 15, 2012

Manufactured by Cook Medical

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Comment by skidoc Commented May 29, 2012

Impact factor: 42

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OK I'm biased, I am a proctor for Cook Medical for IVC filters. But this is the filter I would have if I needed a filter in me.

"But why?" I hear you cry; because we've followed up all filters we have inserted for 25 years, to death or the present, including the Tulips we first placed as part of the original multinational trial, and have yet to find a patient with a clinically significant issue related to the Tulip.

Yes we've had a few recurrent PE's.

Yes, we discovered on US follow up that 3 asymptomatic patients had closed their cavas around the filter, occluding it.

None have moved, none have broken

Do they perforate the cava? Yes, sometimes, but not in a way I feel is significant. Less than some other filters.

Do they come out? Well yes, if you're fairly quick, say up to a month, at that stage they're usually pretty well intimalized in. You can get them out if uou're strong as an ox & twice as clever.BUT........
Why do it?

In our series, which is approaching 20 years for the Tulips, they don't get longterm problems.

They dont get an unusual rate of DVT
They dont get late PE's
They dont need to be anticoagulated longterm

So why take them out?

If you have a young person with no ongoing risk, sure, take out the filter (but why did you put it in originally?) My choice in this situation would be a another filter, probably a Celect, maybe an ALN.

The majority of our filter patients are old, well, at least as old as me, they have malignancy and may be having big operations, often hepatic resections, pseudo myxoma or major joint replacements. I think they have ongoing risks, and, in general, I leave filters in, (having discussed it all with them, consented them in the first place and followed them up myself anyway, obviously!)

The Tulip is easy to place, from groin or jugular (& once from the arm, but the sheath is short, I wouldn't advise it).

It deploys easily, but will tend to lay it's nose against the contralateral wall to the insertion site (except from the neck). It's simple to straighten it if you want to.

I use a sidewinder to quickly identify the renals & bifurcation, and an Angioseal to let me get onto the next case (yeah I know,).

So...if I'm admitted to your hospital, need a filter & wont talk to you, you know which one I want. Thanks Graham Plant

PS Why did I give it 4.5 out of 5? I think it'd look really cool in that blue metallic shade, or in black, then it would be a stealth filter, especially in the photo above. G

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