Patterns of use and outcome of inferior vena cava filters in a tertiary care setting

Abstract

IVC filters are placed in many cases for prophylactic indications. Their low retrieval rates together with relatively high risk of long-term complications, questions their extensive utilization. Prospective trials addressing the safety and efficacy of IVC filters are still warranted.

Inferior vena cava (IVC) filters in children: A 10‐year single center experience

“…In the only prospective randomized controlled trial to assess IVC filter use, it was found that while preventing the occurrence of PE, it came at the expense of a significant risk for DVT, with no survival benefit . Other recognized complications include IVC penetration, filter infection, dislocation, migration, and rupture of the IVC . Our complication rate is similar to the cumulative incidence of the IVC filter‐related complications in children in the available literature with a rate of 16.9% (20/118) .…”

“…IVC filter placement exposes the patient to potential long‐term risks . In the only prospective randomized controlled trial to assess IVC filter use, it was found that while preventing the occurrence of PE, it came at the expense of a significant risk for DVT, with no survival benefit .…”

“…Data obtained included patient demographics (age, sex), indication for IVC filter placement (i.e., contraindications to anticoagulation, catheter‐directed thrombolysis therapy, prophylactically in trauma patients or peri‐operatively), radiologic studies, filter type, duration of filter placement, retrieval data, use of anticoagulation therapy, thrombophilic laboratory evaluation, immediate and long‐term filter‐related complications, and follow‐up data. Feasibility of retrieval in each case was assessed based on the FDA recommendation released on August 2010 to remove filters as soon as mechanical protection from PE is no longer needed (e.g., no contraindications for anticoagulants or no further apparent benefit when placed prophylactically) . In each trauma patient, we calculated the Injury Severity Score (ISS), which was previously found to significantly correlate with mortality .…”

Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population

“…It was not possible to determine how many of the filters were designed to be removed, but published estimates suggest that most filters implanted in recent years would be retrievable [11]. Although considerably higher rates of removal of retrievable filters have been reported by some academic centers [18, 19, 30], other academic centers have reported rates around 9–14% [16, 17, 20]. One institution reported an improvement in retrieval rate from 63 to 100% with the implementation of a clinical pathway [18], suggesting that failure to retrieve at that institution had been due primarily to noncompliance with best practices.…”

“…However, Medicare fee-for-service data reflect overall removal rates of an estimated 1–5% in 2008 [13]. A 2011 systematic review reported an average retrieval rate of 34% across 37 studies of retrievable filters [2], and more recent institutional studies of retrievable filters have reported removal rates of 9–63%, often with the conclusion that removal rates were lower than they should be [16–20]. In one study 25% of 978 patients with IVC filters were discharged on anticoagulants, suggesting transient contraindications, but filters were removed in only 8.5% of patients [16].…”