Vena Cava Filters: Toward Optimal Strategies for Filter Retrieval and Patients' Follow-Up

Abstract

Mortality rates associated with venous thromboembolism (VTE) are high. Inferior vena cava filters (IVCFs) have been frequently placed for these patients as part of their treatment, albeit the paucity of data showing their ultimate efficacy and potential risk of complications. Issues regarding long-term filter dwell time are accounted for in society guidelines. This topic has led to an FDA mandate for filter retrieved as soon as protection from pulmonary embolism is no longer needed. However, even though most are retrievable, some were inadvertently left as permanent, which carries an incremental lifetime risk to the patient. In the past decade, attempts have aimed to determine the optimal time interval during which filter needs to be removed. In addition, distinct strategies have been implemented to boost retrieval rates. This review discusses current conflicts in indications, the not uncommon complications, the rationale and need for timely retrieval, and different quality improvement strategies to fulfill this aim.

Retrieval of a Greenfield Inferior Vena Cava Filter Indwelling for 29 Years

“…7 Other, less likely complications encompass contrast extravasation, renal artery-to-IVC fistula formation, pneumothorax, jugular vein thrombosis, and mortality. 8,9 Our case possesses the longest implantation time by far. Other embedded filters with extended durations of over a decade have also been reported.…”

“…7 Other, less likely complications encompass contrast extravasation, renal artery-to-IVC fistula formation, pneumothorax, jugular vein thrombosis, and mortality. 8,9…”

Inferior Vena Cava Filters: A Clinical Review and Future Perspectives

“…The lack of a planned follow-up for patients is the main reason why optional filters are not retrieved [ 58 ]. It is, therefore, necessary to encourage any program aimed at raising awareness on the importance of a systematic follow-up for these patients [ 66 , 67 , 68 , 69 ] to improve the rate of filter retrieval. Thus, different strategies and organizational models have been proposed.…”

“…Each strategy has costs and possible advantages, which should be carefully evaluated, depending on local resources. Whatever the chosen strategy, a systematic approach to the patient’s follow-up is essential [ 69 ].…”