Inferior Vena Cava Filters and Complications: A Systematic Review

Abstract

Inferior vena cava (IVC) filters have been used since the 1960s to treat patients with acute risk of pulmonary embolism (PE) to prevent migration of thrombus by trapping it within the filter. Traditional usage has been in patients with contraindication to anticoagulation that carry a significant mortality risk. In this systematic review, we sought to evaluate complications associated with placement of inferior vena cava filters based on published data from the past 20 years. A search was performed on October 6th, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews, using three databases (ProQuest, PubMed and ScienceDirect) for articles published between the dates of February 1, 2002 and October 1, 2022. Results were filtered to include full-text, clinical studies, and randomized trials written in English pertaining to keywords “IVC filter AND complications”, “Inferior Vena Cava Filter AND complications”, “IVC filter AND thrombosis” and “Inferior Vena Cava Filter AND thrombosis”. Articles identified by the three databases were pooled and further screened for relevance based on inclusion and exclusion criteria. Initial search results yielded 33,265 hits from all three databases combined. Screening criteria were applied, with 7721 results remaining. After further manual screening, including removal of duplicate hits, a total of 117 articles were selected for review. While there are no consensus guidelines for best practice, there is compelling evidence that IVC filters can provide significant protection against PE with minimal complications if the treatment window is appropriate. Increase in the variety of filter models has led to broader availability, but skepticism remains about their efficacy and safety, with ongoing controversy surrounding appropriate indications. Further research is needed to establish clear guidelines on appropriate indications for IVC placement and to determine time course of complications versus benefits for indwelling filters.

Inferior Vena Cava Filter Long Term Complications and Retrieval Techniques: A Case Series and Literature Review

“…These complications included IVC filter thrombosis (7%, CI 5.0-10.6), recurrent DVT (5%, CI 3.1-7.8) and recurrent PE (3%, CI 1.7-5.6). 18 Also, another study reported a similar complication rate (20.6%) of 382 filters, where DVT was the most common (39%), followed by IVC thrombosis (32%), new/recurrent PE (18%) and other thrombosis (11%). 19…”

“…A systematic review found that higher rates of IVC filter perforation and fracture in permanent filters compared to retrievable ones, especially with Cordis Optease and TrapEase filters. 18 In concordance, fracture of the filter limbs is directly associated to indwelling time of the filter and IVC injury. 18 Currently, the risk of fracture among IVC filters is a matter of study and further research is needed.…”

“…18 In concordance, fracture of the filter limbs is directly associated to indwelling time of the filter and IVC injury. 18 Currently, the risk of fracture among IVC filters is a matter of study and further research is needed. 18…”

“…18 Currently, the risk of fracture among IVC filters is a matter of study and further research is needed. 18…”

“…Most patients don’t experience symptoms; however, symptomatic cases account for one in 10 perforations and warrant retrieval. 18 Open retrieval techniques include primary repair of a longitudinal venotomy and performing a small cavotomy with purse-string sutures to close the defect, patch venoplasty, removal of extracaval struts and securing of the IVC filter struts, and snare technique of an extraluminal hook. 20…”