Ronan F. J. Browne

Internal jugular and common femoral venous access for the removal of a long-term embedded vena cava filter.

We describe an inferior vena cava filter retrieval technique requiring triple venous access performed in a 35-year-old male who was referred for filter removal 16 months after its insertion. The filter showed a right-sided tilt with endothelialization of the distal filter struts into the caval wall. Access was required via both internal jugular veins to straighten the filter using a snared-loop technique. Further 18 F right common femoral vein access was required to snare and remove the filter, which could not be completely collapsed distally due to endothelialized tissue, precluding normal removal via the jugular venous route.

Transitional cell carcinoma

Transitional cell carcinoma is a common urological malignancy and in up to 5% of cases occurs in the kidney. The multicentric nature of TCC makes assessment of the entire urothelium essential prior to treatment. Vigilant urological and radiological follow-up is also warranted post-treatment to assess for metachronous lesions and recurrence. Conventional imaging modalities, such as IVU, RP, and US, still play a pivotal role in the assessment of hematuria in conjunction with endourological techniques. The recent advent of minimally invasive surgery that allows renal preservation makes accurate staging, usually with CT or MR imaging, mandatory to determine appropriate therapy. The technique of CTU has recently developed and offers superior detection of urinary tract tumors and calculi, as well as the ability to assess perirenal tissues and stage lesions, as a single comprehensive study. In the future, it is probable that CTU will become the standard investigation in the initial assessment and follow-up of patients with suspected TCC. Similar MR imaging protocols can also be used in patients not suitable for CTU, although detection of calculi may be suboptimal.