Five-Year Follow-up of Prophylactic Vena Cava Filters in High-Risk Trauma Patients

Abstract

Objective: To assess the short-and long-term outcomes of vena cava filter (VCF) placement for prophylaxis against pulmonary embolism in patients at high risk due to trauma.Design and Setting: Case series at a level I trauma center.Patients: Patients were considered for prophylactic VCF placement if they met 1 of the injury criteria-spinal cord injuries with neurologic deficit, severe fractures of the pelvis or long bone (or both), and severe head injuryand had a contraindication to anticoagulation.Intervention: Vena cava filters were placed percutaneously by the interventional radiologists when the acute trauma condition was stabilized following admission. Main Outcome Measures:Filter tilt of 14°or more, strut malposition, insertion-related deep vein thrombosis, pulmonary embolism, or inferior vena cava patency.Results: There were 132 prophylactic VCFs placed. A 3.1% rate of insertion-related deep vein thrombosis occurred, all of which were asymptomatic. Filter tilt occurred in 5.5% of patients and strut malposition in 38%. Three cases of pulmonary embolism (1 fatal) occurred in a prophylactic VCF, and all patients had either filter tilt or strut malposition. The risk of pulmonary embolism developing was higher in those patients with filter tilt or strut malposition than in those who did not have these complications (6.3% vs 0%; P=.05; Fisher exact test). The 1-, 2-, and 3-year inferior vena cava patency rates (±SD) were 97%±3%.Conclusions: Prophylactic VCF can be placed safely with an acceptable rate of insertion-related deep vein thrombosis and long-term inferior vena cava patency. Patients with prophylactic VCF remain at risk for pulmonary embolism if the filter is tilted 14°or more or has strut malposition. In such patients, consideration should be given to placing a second filter.

Complications of inferior vena cava filters

“…Tilt was found to be the most common cited cause for failure to retrieve filters (5). Rogers et al found that filters tilted greater than 14 degrees had an association with an increase in PE and recommended addition of a second filter for adequate prophylaxis (7,13). Studies on Greenfield IVC filters (Boston Scientific, Natick, MA, USA) showed an incidence of tilt in 5% of © Cardiovascular Diagnosis and Therapy.…”

Numerical Analysis of the Mechanical Properties of a Vena Cava Filter

“…2) (Ando & Kuribayashi, 2000;Boston Scientific, 2007;Greenfield et al, 1990Greenfield et al, , 1991Kinney et al, 1997;Nara et al, 1995;Rogers et al, 1998;Streiff, 2000;Swaminathan et al, 2006). This permanent filter is commonly used in Japan.…”

“…Moreover, the filter should not move in the blood vessel after deployment and should pass smoothly through the slim introducer catheter. Although insertion appears to be a safe and effective method by which to prevent the recurrence of pulmonary embolism, patients in whom the filter has become tilted may experience pulmonary embolism recurrence because of a decrease in the thrombus-trapping performance of the filter (Nara et al, 1995;Rogers et www.intechopen.com al., 1998). In order to satisfy these requirements, several types of filters, such as permanent, temporary, and retrievable filters, have been proposed.…”

“…In order to satisfy these requirements, several types of filters, such as permanent, temporary, and retrievable filters, have been proposed. For example, several types of vena cava filters, such as Greenfield filter, Vena Tech filter, Bird's nest filter, Simon-Nitinol filter, TrapEase filter, Günther tulip filter, Antheor filter, Neuhaus protect filter, and RecoveryNitinol filter, have been developed (Ando & Kuribayashi, 2000;Boston Scientific, 2007;Greenfield et al, 1990Greenfield et al, , 1991Kinney et al, 1997;Nara et al, 1995;Rogers et al, 1998;Streiff, 2000;Swaminathan et al, 2006). However, there are few quantitative data on the mechanical properties of these filters.…”

Experiência preliminar com novo filtro de veia cava: resultados de 15 implantes

“…A inclinação do filtro de Greenfield na veia cava não é uma complicação freqüente, ocorrendo entre 5,5 a 10% dos casos 14,15 . Entretanto, quando ocorre, está associada à perda da eficiência na captura de êmbolos 3,16 , além de favorecer a extrusão das hastes 17 , as quais, por sua vez, podem provocar a perfuração de estruturas vizinhas à veia cava, como ureter, vísceras e aorta 18 .…”