Superior vena cava filter placement over existing central venous lines: Is line removal necessary?

Abstract

Objectives To evaluate the technical feasibility and clinical safety of superior vena cava (SVC) filter placement over preexisting central venous lines (CVLs) in 23 patients who had upper extremity deep venous thrombosis with contraindications to anticoagulation. Methods A retrospective review of the images and electronic medical records of 23 patients from 2008 to 2018 with SVC filters placed over an existing central venous line was performed in a single tertiary medical center. Twenty‐one filters were placed over smaller lines (<8 Fr), and two were placed over hemodialysis catheters. Venograms before and after filter placement were compared to detect any evidence of line displacement or entrapment. Medical records were reviewed to determine whether there was any difficulty during line removal. Results In two of five patients with dual lines, significant line displacement was noted in the left‐sided lines, both lines were later removed without complications. In one patient with a hemodialysis catheter, the filter was deployed over the tip of the catheter resulting in the entrapment of one of the legs of the filter within a side hole of the line. Fourteen patients had their lines later removed 3 days to 3 months after filter placement without reported problems. Nine patients had their CVLs left in place until the patient's death or discharge to a long‐term facility. Conclusions SVC filter placement over preexisting CVLs seems to be technically feasible and clinically safe in patients with <8‐Fr CVLs. However, placement of the filters over hemodialysis catheters can result in leg entrapment.

Inferior Vena Cava Filters: An Overview

“…Despite increasing incidence of UEDVT with the development and use of peripherally inserted central lines, the overall incidence of UEDVT remains low, accounting for only 4% to 6% of all DVTs. 20 Placing filters in the superior vena cava (SVC) to prevent PE in patients with known UEDVT remains controversial and is considered an off-label use, as currently no FDA-approved SVC filter exists. 10,20 One comprehensive literature review of 21 publications describing SVC filter use found only a 5.6% incidence of PE in patients with UEDVT and a mortality rate from PE of 0.7%, which they concluded was not enough evidence to demonstrate significant risk of UEDVTs.…”

“…20 Placing filters in the superior vena cava (SVC) to prevent PE in patients with known UEDVT remains controversial and is considered an off-label use, as currently no FDA-approved SVC filter exists. 10,20 One comprehensive literature review of 21 publications describing SVC filter use found only a 5.6% incidence of PE in patients with UEDVT and a mortality rate from PE of 0.7%, which they concluded was not enough evidence to demonstrate significant risk of UEDVTs. 10 Another single-center 10-year retrospective review came to a similar conclusion and further identified a significant rate of complications, such as filter misplacement, SVC perforation and/or thrombosis, recurrent pneumothorax, and filter tilting.…”

“…10 Another single-center 10-year retrospective review came to a similar conclusion and further identified a significant rate of complications, such as filter misplacement, SVC perforation and/or thrombosis, recurrent pneumothorax, and filter tilting. 20 Leg perforation, when a strut or leg of the filter punctures through the venous wall, is a known complication of IVC filters that is generally asymptomatic. 20 However, this complication becomes much more problematic with SVC placement due to the close proximity of the aorta, duodenum, kidneys, and vertebral bodies.…”

“…20 Leg perforation, when a strut or leg of the filter punctures through the venous wall, is a known complication of IVC filters that is generally asymptomatic. 20 However, this complication becomes much more problematic with SVC placement due to the close proximity of the aorta, duodenum, kidneys, and vertebral bodies. 20 In this study, the leg perforation was found in 10 of 24 patients with available post-filter imaging, although the authors admit that a high lost-to-followup rate made it difficult to draw conclusions about the significance of this complication.…”

“…20 However, this complication becomes much more problematic with SVC placement due to the close proximity of the aorta, duodenum, kidneys, and vertebral bodies. 20 In this study, the leg perforation was found in 10 of 24 patients with available post-filter imaging, although the authors admit that a high lost-to-followup rate made it difficult to draw conclusions about the significance of this complication. 20 Because of insufficient evidence to suggest that the benefits of placing an SVC filter outweigh the risks, most studies do not advocate for their use.…”