Denali Flashcards
Denali Indications
for us in the prevention of recurrent pulmonary embolism via permanent placement in the vena cava
Denali is used when
- anticoagulants are contraindicated
- failure of anticoagulation therapy
- emergency treatment following massive PE
- chronic, recurrent PE where anticoagulant therapy has failed or its contraindicated
goals of an optional IVC filter
- protect against PE
- long-term retrievability
- stability in the vena cava
- avoid complications
what was the first filter to recieve a retrieval indication in the U.S?
- Bard Recovery filter
- bi-level filtration to trap large and small emboli
- bullet-tip for retrival with the recovery cone removal system
Order of Bard filter creations
- recovery
- G2
- G2 express
- G2x
- eclipse
- Meridian
how many legs/arms does denali have?
- 6 arms/legs
- 12 total
what are some design features of denali
- electropolished one-piece nitinol filter body
- dual level filtration
- conical design
- dual-level filtration
T/F: Denali is both a permanent and retrievable device
True
Study Design
- prospective, multicenter, single arm
- 200 patients followed 2 years post-placement or 30 days post-retrieval
- reviewed by independant core lab
The technical success for the filter placement is ___, where the clinical success is ___.
- 99.5%
- 95.0%
the technical success for filter retrieval is ___, where the clincal is ____.
- 97.6%
- 99.2%
In the of Denali® Study, what was the mean and max indwell time of the filter?
201, 736
Select 3 significant design differences of Denali vs. previous generations of Bard IVC filters
- one piece body
- staggered leg lengths
- robust hook
What Size sheaths come in our SRK30 Denali retrieval system?
9Fr, 11Fr
The filter maintained high retrieval success in ___ patients over indwells of ______ days
- 121
- 5-736
contraindications for denali use
- patients with IVC larger than 28 mm
- risk of PE
- uncontrolled sepsis
- hypersensitivity to nikel-titanium alloys
- pregnant patients when fluoroscopy may endanger the fetus
when should the filter not be retrieved?
if there is a significant amount of thrombus near the filter
Pulmonary embolism causes death in ___ amount of people
30%
Ideal placement is
1 cm below the renal vein
What program is offered in conjunction with Denali filters?
reach
What is the gold standard for DVT treatment?
Anticoagulation
What are the 2 radiopaque markers on Denali introducer sheath for?
28cm distance used to calibrate fluoro to accurately measure IVC vessel size
Pros for femoral access
- may be easier for physican
- may be less traumatic for patient
- avoids proximity to the heart
cons for femoral access
- may traverse through clot
- potentially longer recoup time for patient
- may be more difficult to insert deployment system straight
jugular access pros
- may avoid transversing through clot
- may be easier to insert deployment system straight
- potentially less recoup time for patient
jugular access cons
- may be more difficult to pin wire and deploy
- must pass near the heart
Understand steps in Denali deployment
Deployed in 1 smooth continuous motion
improper deployment precautions
- if misplacement, sub-optimal placement, or tiliting of the filter occurs, consider immediate removal
- do not attempt to reposition the filter
Argon filter
option
where denali wins against argon
- clot trapping
- tilt resistence
- migration resistence
- retrieval- snare hook strength
cook filter/s
tulip, celect
off label physican use
- no DVT/PE but at high risk for development
- “window maker” thrombus with poor respiratory/ pulmonary reserve
- metastatic disease (cancer)
- prophylactic placement in high risk surgical patients
- trauma/ bariatric
- spinal cord injury
-severe bone fractures - patient who “falls a lot”; unreliable patient
