Indications, Complications, and Management of Inferior Vena Cava Filters

Abstract

Importance: Retrievable inferior vena cava (IVC) filters were designed to provide temporary protection from pulmonary embolism, sparing patients from long-term complications of permanent filters. However, many retrievable IVC filters are left in place indefinitely.Objectives: To review the medical records of patients with IVC filters to determine patient demographics and date of and indication for IVC filter placement, as well as complications, follow-up data, date of IVC filter retrieval, and use of anticoagulant therapy.Design and Setting: A retrospective review of IVC filter use between August 1, 2003, and February 28, 2011, was conducted at Boston Medical Center, a tertiary referral center with the largest trauma center in New England.Participants: In total, 978 patients. Twenty six patients were excluded from the study because of incomplete medical records.Intervention: Placement of retrievable IVC filter.Main Outcome Measures: In total, 952 medical records were included in the analysis.Results: Of 679 retrievable IVC filters that were placed, 58 (8.5%) were successfully removed. Unsuccessful retrieval attempts were made in 13 patients (18.3% of attempts). Seventy-four venous thrombotic events (7.8% of 952 patients included in the study) occurred after IVC filter placement, including 25 pulmonary emboli, all of which occurred with the IVC filter in place. Forty-eight percent of venous thrombotic events were in patients without venous thromboembolism at the time of IVC filter placement, and 89.4% occurred in patients not receiving anticoagulants. Many IVC filters placed after trauma were inserted when the highest bleeding risk had subsided, and anticoagulant therapy may have been appropriate. While many of these filters were placed because of a perceived contraindication to anticoagulants, 237 patients (24.9%) were discharged on a regimen of anticoagulant therapy. Conclusion and Relevance:Our research suggests that the use of IVC filters for prophylaxis and treatment of venous thrombotic events, combined with a low retrieval rate and inconsistent use of anticoagulant therapy, results in suboptimal outcomes due to high rates of venous thromboembolism.

Defining Prolonged Dwell Time: When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary?

“…Given that a large proportion of rIVCFs remain in situ indefinitely, 3 it is particularly troubling that there have been increasing reports of complications associated with these devices, including filter fracture, migration, organ penetration, and increased risk of deep venous thrombosis. 11,24 In a review of the Food and Drug Administration's own Manufacturer and User Facility Device Experience database, Andreoli et al 25 reported that ≈87% of user-reported adverse events were associated with rIVCFs, as opposed to ≈13% associated with permanent inferior vena cava filters.…”

“…1,2 In practice, however, the majority of rIVCFs are left in place permanently, with historic retrieval rates as low as 8.5%. [3][4][5] Although poor clinical follow-up of patients with these devices plays an important role, 6 prolonged filter implantation has been associated with retrieval failure rates as high as 43%. [7][8][9][10][11] Furthermore, prolonged rIVCF dwell time is associated with device-related complications, including fracture, migration, organ penetration, and increased risk of deep venous thrombosis.…”

Retrieval of TRAPEASE and OPTEASE Inferior Vena Cava Filters with Extended Dwell Times

“…One of the difficulties encountered in removing these types of filters is the extensive neointimal hyperplasia that develops along the struts. Given the relatively short removal window of the OPTEASE filter and the overall low rates of filter retrieval (5), it is likely that a sizeable number of patients are living with OPTEASE and TRAPEASE filters that may no longer be required.…”

Thromboprophylaxis patterns and determinants in critically ill patients: a multicenter audit

“…Despite recommendations against the use of inferior vena cava filters for venous thromboembolism events and prophylaxis [14,36,39] and clear evidence that they cause thrombosis, the filters continue to be widely used for prevention. Although we did not examine removal rates in this audit, it is also concerning in real-world practice that less than 20% of retrievable filters are actually removed [40]. …”