Vena Cava Filters: Current Concepts and Controversies for the Surgeon

Complications of inferior vena cava filters

“…There have been case reports of filter placements in the gonadal veins, one such case leading to hydronephrosis and thrombosis of the ipsilateral ovarian vein (26). There have been reports of misplacements of filters in the mesenteric veins, in the aorta which was discovered on transesophageal echocardiogram, and even in the spinal column after perforation of the sheath into the retroperitoneum, vertebral foramina and ultimately the spinal canal (7,27,28). As such, cavagram prior to the insertion is vital to assess the vascular anatomy and correct placement of the filter.…”

“…Tilt was found to be the most common cited cause for failure to retrieve filters (5). Rogers et al found that filters tilted greater than 14 degrees had an association with an increase in PE and recommended addition of a second filter for adequate prophylaxis (7,13). Studies on Greenfield IVC filters (Boston Scientific, Natick, MA, USA) showed an incidence of tilt in 5% of © Cardiovascular Diagnosis and Therapy.…”

“…Though common, significant bleeding requiring transfusion or surgical intervention is very rare in published literature suggesting it carries a low morbidity. Incidence of thrombosis at the access site ranges between 2-35% and occurs more commonly in patients with a known underlying hypercoagulability (7). Variability stems from whether follow-up evaluations included ultrasound imaging.…”

“…A filter being undersized for the vena cava may lead to migration. Most filters on the market are currently approved for vena cava of 28 mm or less in diameter with the exception of the Bird's Nest filter which can be placed in a vena cava up to 40mm in diameter (7,9). Additionally, placement of central lines can dislodge a filter.…”

Surgical intensive care unit—the trauma surgery perspective

“…A Doppler ultrasound or duplex should be performed on patients with clinical symptoms of DVT or based on screening protocols (<48 h after admission and every 5-7 days on ICU). Furthermore, a temporary inferior vena caval filter placement should be considered for the highest-risk patients with contraindications for full anticoagulation and severe lung-injured patients with right heart failure (ARDS), dying from a small pulmonary embolism [74].…”