Changes in inferior vena cava filter placement over the past decade at a large community-based academic health center

Abstract

Technological and practice pattern changes have led to an increase in filters inserted by vascular and trauma surgeons in the operating room and intensive care units. Increased diagnosis of VTE disease and newer low profile delivery systems in patients may also have contributed to the significant increase in filter placement. A shift in indications for placement from absolute toward relative indications and prophylaxis is evident over time and across providers, indicating the need for consensus development of appropriate criteria.

British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry

“…The development of retrievable filters has expanded the use of IVC filters and led to an increase in the implantation of IVC filters in patients with a wider range of prophylactic indications [4]. All retrievable IVC filters can function as permanent filters if they are not removed.…”

“…All retrievable IVC filters can function as permanent filters if they are not removed. Several studies have indicated that only a small percentage of retrievable IVC filters (2-20 %) are removed and device related complications have been reported [4][5][6][7][8]. Recently the U.S. Food and Drug Administration issued a medical alert to address these considerations and emphasized filter removal as soon as protection from PE is no longer necessary [9].…”

Advanced Techniques for Removal of Retrievable Inferior Vena Cava Filters

“…Their use has become commonplace, and the numbers implanted increase annually. During the last 3 years, in the United States, the percentage of annually placed optional filters, i.e., filters than can remain as permanent filters or potentially be retrieved, has consistently exceeded that of permanent filters [1][2][3]. In parallel, the complications of long-or short-term filtration have become increasingly evident to physicians, regulatory agencies, and the public [4][5][6][7][8][9][10][11][12][13][14].…”

“…It becomes logical that if an optional filter carries no greater risks than a permanent one, that it becomes the primary device used; this is reflected in the aforementioned market trends [2,3,5]. As filter retrieval becomes less of an ''optional'' event, dedicated physician and practice mechanisms to enhance retrieval rates will be required.…”

“…As filter retrieval becomes less of an ''optional'' event, dedicated physician and practice mechanisms to enhance retrieval rates will be required. Current published reports describe a broad range of retrieval rates from 1.0 to 40.5% [3,[48][49][50][51][52][53][54][55]. Minocha et al showed the value of this type of a proactive program: Once implemented, IVC retrieval rates increased from 29 to 60% [56].…”