Form And Function Of Vena Cava Filters: How Do Optional Filters Measure Up?

Abstract

The function of vena cava filters, preventing pulmonary embolism while maintaining caval patency, is associated with the design. Several characteristics have been reported. This report evaluates retrievable filter designs in comparison with previously marketed designs with respect to efficacy and safety. Three inferior vena cava (IVC) filters (Gunther Tulip, Bard Recovery, and the Cordis OptEase) were compared on the basis of design characteristics associated with function, shape, number of trapping levels, and fixation. Adverse events reported in the literature and to the US Food and Drug Administration Manufacturers and User Facility Device Experience Database (MAUDE) were summarized. The major differences among device types include the fixation, the volume and number of trapping levels, and the amount of metal in the IVC. The MAUDE registry reported adverse events that had been hypothesized from the analysis of in vitro and in vivo testing. The Recovery and OptEase filters had the highest number of clinically important reports. From 12 to 57% were retrieved between 3 days and 11 months. Adaptations made to facilitate retrieval led to unacceptable sequelae. The small number removed, the length of time they are left in place, and the risks associated with retrieval suggest that optional filters may not be equivalent to approved permanent devices.

Spanish multicenter real – life registry of retrievable vena cava filters (REFiVeC)

“…Until the publication of H Decousus, et al in 1998(Decousus et al 1998, even with little clinical evidence, no one questioned the usefulness of inferior vena cava filter (IVCF) for the prophylaxis and treatment of VTD (Proctor and Greenfield 2008;Athanasoulis et al 2000;Stein et al 2004;Dalen and Stein 2013). It was Decousus, et al and the PREPIC study (PREPIC Study Group 2005) that demonstrated that IVCF represents a potential benefit with protection against life-threatening pulmonary embolism in a short-term; however, with a higher risk of symptomatic DVT in a long-term without mortality difference at 8 years of follow-up.…”

The use of retrievable inferior vena cava filters in severely injured military trauma patients

“…21 It was interesting, however, that there were no other detected insertion site or de novo DVT. This has been estimated to occur in 3 to 40% of patients after IVCF placement, [22][23][24][25] but the etiology and subsequent clinical significance are unclear.…”

The Future of Deep Venous Thrombosis and Post-thrombotic Syndrome in 2020

“…However, they characteristically have high non-retrieval rates and higher caval occlusion rates than the standard Greenfield filter. 13,14 There is growing use of IVC filters in patients without DVT or PE. There are no studies which support this approach, and there are observations of high rates of non-retrieval and caval occlusion in patients treated with these ‘expanded’ indications.…”