Retrievable vena cava filters: A clinical review

Abstract

Vena cava filters were developed as a method of preventing pulmonary embolism (PE) in patients with venous thromboembolism (VTE) at risk for bleeding from therapeutic anticoagulation. However, the long‐term complications of filter placement, such as caval thrombosis, have mitigated some of the benefits, particularly in those patients with only a temporary contraindication to anticoagulation. Retrievable filters were designed to avoid the long‐term risks of a permanent filter while still providing short‐term protection against PE. As a result, their use has expanded from patients with known thrombosis to those without VTE who are at high risk for developing PE. In this review, we discuss the different types of retrievable filters, indications for their placement, complications that can occur during and after placement, and their use as prophylaxis in surgical patients. Although the use of retrievable filters in patients with known VTE is clear, further studies are needed to establish their prophylactic efficacy in the surgical patient. Until this evidence is available, we recommend that retrievable filters should be used only in patients with acute VTE who are at risk for recurrent thromboembolism and have a transient risk for bleeding. Journal of Hospital Medicine 2009;4:441–448. © 2009 Society of Hospital Medicine.

Radiopaque Resorbable Inferior Vena Cava Filter Infused with Gold Nanoparticles

“…Inferior vena cava (IVC) filters are currently used for prevention of venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, when anticoagulants are contraindicated, bleeding complications occur during antithrombotic treatment, or VTE recurs despite optimal anticoagulation 1, 2 . IVC filter use has grown rapidly in recent years with the advent of retrievable IVC filters, which mitigate some of the risks associated with permanent IVC filters 1, 2 .…”

“…IVC filter use has grown rapidly in recent years with the advent of retrievable IVC filters, which mitigate some of the risks associated with permanent IVC filters 1, 2 . However, only 22% of the patients get their retrievable IVC filter retrieved due to poor patient follow-up and other technical difficulties 3 .…”

Death and venous thromboembolism after lower extremity amputation

“…No difference in the rates of PE among patients with or without prophylactic IVC filters were found in a meta analysis of prospective studies [19]. Moreover, there are no RCTs concerning the prophylactic use of IVC filters in any patient population [17,18]. Because of lack of evidence of efficacy and high costs, we can not recommend the use of IVC filters as thromboprophylaxis in patients who will have an amputation.…”

“…Inferior vena cava (IVC) filters are reserved for patients with proven proximal DVT and either an absolute contraindication to full‐dose anticoagulation or planned major surgery in the near future [17,18]. The use of IVC filters as thromboprophylaxis has expanded recently, because of the introduction of retrievable filters.…”

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

“…However, the overall benefit these patients obtain from such an intervention is uncertain. Several studies have shown that patients with cancer and VTE who receive IVC filters are often at a terminal stage in their disease and often die during the same hospitalization or soon after hospital discharge [3,4]. One randomized controlled trial revealed that while IVC filters reduce the risk of pulmonary embolism (PE) in patients with VTE who are receiving anticoagulation, they also potentially increase the risk of developing lower extremity deep venous thrombosis (DVT) with long-term use [5].…”