Retrievable inferior vena cava filters in patients with cancer are safe but are they beneficial?

Abstract

The availability and insertion of permanent and retrievable inferior vena cava filter devices have increased substantially over the past decade. Our retrospective study provides the first detailed assessment of the safety and efficacy of retrievable inferior vena cava filters in a large cohort of cancer patients with predominantly advanced malignancies. We retrospectively reviewed the medical records of consecutive patients with the diagnosis of cancer who underwent inferior vena cava filter placement at a single academic medical center from 2007 to 2012 with special attention to safety, recurrent venous thromboembolism, and survival data. Three hundred thirty-seven cancer patients were included in the analysis. Gastrointestinal, lung, and genitourinary malignancies were the most commonly represented malignancies [94 (27.8 %), 70 (20.8 %), and 37 (10.9 %) patients, respectively]. Immediate complications were diagnosed in one of 258 (1 %) evaluable patients following placement of a retrievable filter. Delayed complications occurred in 23 of 258 (8 %) patients. The 7, 14, 30, 90, and 365 day post-filter survival rates for patients with stage IV cancer were 0.91, 0.86, 0.71, 0.52, and 0.29, respectively. Patients with lung and gastrointestinal tumors demonstrated a significantly reduced post-filter survival rate compared with those with genitourinary, brain, and breast cancers. Retrievable and non-retrievable inferior vena cava filters are associated with an overall low rate of complications in patients with cancer. However, survival rates following filter placement are poor in this patient population.

Cancer-Associated Thrombosis: Beyond Clinical Practice Guidelines—A Multidisciplinary (SEMI–SEOM–SETH) Expert Consensus

“…While some studies suggested that IVCFs are safe and effective, others found an increased risk of recurrent deep venous thrombosis (DVT; indeed, the cancer-related hypercoagulability is not corrected by the IVCF), as well as no benefit regarding pulmonary embolism (PE) incidence or short-term mortality. [34][35][36][37][38][39][40] Nevertheless, most guidelines recommend the use of IVCF in cancer patients with proximal acute DVT or PE when anticoagulant therapy is contraindicated. [41][42][43][44] Such is the case of major surgery or invasive procedures.…”

“…• Results from studies on the use of IVCF in cancer patients with VTE are controversial. [34][35][36][37][38][39][40] • Consensus exists on its use in patients with PE or DVT when ACG is contraindicated, especially in the first weeks after VTE. [41][42][43][44] • Concern about early and delayed adverse effects associated with IVCF is increasingly growing.…”

The Role of Inferior Vena Cava Filters in Cancer Patients

“…They also noted that survival rates were low in their population, and that the retrieval rates were less than 2%. 61 Abtahian and colleagues also performed a retrospective review and reported similar findings, although these authors noted a higher retrieval rate (28%). 62 Indeed, the analysis of 646 consecutive cancer patients by the authors of this article has demonstrated that individuals with metastatic disease have significantly lower retrieval rates than cancer patients with limited disease, and are twice as likely to have a retrievable filter remain as a permanent device (OR: 1.99, 95% CI: 1.07-3.68, p ¼ 0.03).…”

Are there any risk factors for developing complications with the use of retrievable vena cava filters in orthopaedic surgery?

“…23 Oncologic patients definitely have a higher predisposition for thromboembolic events due to multiple causes: extrinsic vascular compression, tumor vascular infiltration, hypercoagulability induced by cancer-related cytokines, and pro-thrombotic chemo and radiotherapies. [24][25] Mikhail et al 26 determined that there was a low overall complication rate after using retrievable VCFs in cancer patients. However, as retrievability was 2% and the mortality rate was almost 50% at 90 days, the authors concluded that end-stage patients might not benefit from the use of such filters.…”