Retrievable Inferior Vena Cava Filters: A Tertiary Centre Perspective and Quality Assurance Study

2019 ◽  
Vol 70 (2) ◽  
pp. 193-198 ◽  
Author(s):  
Ramin Hamidizadeh ◽  
David Liu ◽  
Faisal Khosa ◽  
John Chung ◽  
Darren Klass ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Inferior Vena Cava ◽  
Median Time ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Filter Placement ◽  
Filter Retrieval ◽  
Filter Insertion

Purpose To conduct a retrospective review and quality assurance study of inferior vena cava (IVC) filter retrieval over a two-year period at a tertiary care centre. Methods Patients who underwent IVC filter placement or retrieval over a two-year period were identified. Medical records were reviewed for patient characteristics, filter indication, time to filter retrieval, and complications. Results IVC filters were placed in 229 patients between January 1, 2015 and December 31, 2016. 113 retrievals were attempted and 101 filters were successfully retrieved (89.4%). Median time to first retrieval attempt was 48 days (range of 5–728). Seventy-one patients died in the interval after filter insertion before a retrieval attempt at a median time of 27 days (range of 3–430). In 17 patients, retrieval was complicated by or delayed because of penetration of IVC wall (n = 6), large thrombus burden trapped by filter (n = 5), filter tilt or migration (n = 3), and unclear reasons (n = 3). Time-to-first unsuccessful retrieval attempt was 141 days (median). Of all filters placed, 55.9% were never retrieved. Excluding deceased patients with in-situ filters (n = 71) and unsuccessful retrievals left in-situ as permanent filters (n = 5), there remains 52 patients (33%), with a median filter in-situ time of 488 days. Conclusion Our study indicates that as many as 33% of patients may have been lost to follow-up of their in-situ IVC filter. Considering widespread reports of long-term complications and the recent safety alert issued by Health Canada, it is evident that a unified strategy is needed to track patients post filter insertion.

scholarly journals Practice patterns of retrievable inferior vena cava filters and predictors of filter retrieval in patients with pulmonary embolism

2017 ◽  
Vol 22 (6) ◽  
pp. 512-517 ◽  
Author(s):  
Jieun Kang ◽  
Heung-Kyu Ko ◽  
Ji Hoon Shin ◽  
Gi-Young Ko ◽  
Kyung-Wook Jo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena Cava ◽  
Predictive Factors ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Retrieval Rate ◽  
Filter Retrieval ◽  
Ivc Filters ◽  
Filter Insertion

Retrievable inferior vena cava (IVC) filters are increasingly used in patients with venous thromboembolism (VTE) who have contraindications to anticoagulant therapy. However, previous studies have shown that many retrievable filters are left permanently in patients. This study aimed to identify the common indications for IVC filter insertion, the filter retrieval rate, and the predictive factors for filter retrieval attempts. To this end, a retrospective cohort study was performed at a tertiary care center in South Korea between January 2010 and May 2016. Electronic medical charts were reviewed for patients with pulmonary embolism (PE) who underwent IVC filter insertion. A total of 439 cases were reviewed. The most common indication for filter insertion was a preoperative/procedural aim, followed by extensive iliofemoral deep vein thrombosis (DVT). Retrieval of the IVC filter was attempted in 44.9% of patients. The retrieval success rate was 93.9%. History of cerebral hemorrhage, malignancy, and admission to a nonsurgical department were the significant predictive factors of a lower retrieval attempt rate in multivariate analysis. With the increased use of IVC filters, more issues should be addressed before placing a filter and physicians should attempt to improve the filter retrieval rate.

scholarly journals Inferior Vena Cava Filter Retrieval Trends: A Single Center Experience

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4690-4690
Author(s):  
Filip Ionescu ◽  
Nwabundo Anusim ◽  
Eva Ma ◽  
Lihua Qu ◽  
Leann Blankenship ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Thromboembolic Events ◽  
Single Center ◽  
Filter Placement ◽  
Filter Retrieval ◽  
Ivc Filters ◽  
Age At Placement

Background: Inferior vena cava (IVC) filters are indicated in patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) who either have contraindications to or have failed anticoagulation (AC). Given rising concerns about their safety and efficacy, the FDA has issued a communication urging clinicians to remove filters (optimally, within 90 days post-implantation). According to national data retrieval rates remain low. Our study aimed to assess IVC filter retrieval rates and factors that influence retrieval. Methods: This is a single center, retrospective cohort study of patients who had IVC filter placement between December 2015 and December 2018. Subjects were identified using procedural codes for IVC filter insertion; data regarding demographics, comorbidities, retrieval, IVC filter-related complications and subsequent thromboembolic events were obtained by direct chart review. Survival analyses and a Cox regression model were performed using JMP statistical software. Results: Over 3 years, 494 patients with IVC filters were identified; 305 (62%) were retrievable. The average age at placement was 69±16 years; 249 (50%) were men and 332 (67%) were Caucasian. After excluding patients who died or were lost to follow-up within 30 days of placement or were discharged to hospice from the index admission, 258 patients with retrievable filters remained (54 retrieved). Indications for IVC filter placement were PE ± DVT 90 (35%), proximal DVT 159 (62%) and prophylactic 9 (3%). Forty two percent of patients (109) were restarted on AC at discharge, while an additional 18% (total 155) received AC at some point thereafter. The rate of retrieval was 8% at 90 days, 23% at 1 year and 28% at 2 years (Figure A). The proportional hazards model identified resumption of AC at any time (HR 3.11, 95%CI 1.6-6.8, p=0.0006) as the strongest predictor of retrieval; AC at discharge was not predictive. Advanced age at placement (HR 0.97 per unit change, 0.96-0.99, p=0.004) and active malignancy (HR 0.5, 95%CI 0.24-0.98, p=0.04) were associated with a lower likelihood of retrieval. The initial thrombotic event, the reversibility of the contraindication to AC, the placing service, sex, ethnicity and other comorbid conditions did not have an impact on retrieval. Kaplan-Meier analysis revealed that subjects who ever resumed AC had significantly higher rates of retrieval at 90 days (11% vs 3.4%) and at 1 year (33% vs 9.7%, log-rank p=0.0003, Figure B) when compared to those who did not. Only four patients experienced IVC filter-related complications (2 filter thrombosis, 1 IVC penetration, 1 device tilting); all occurred 2 or more years after placement. Recurrent thromboembolic events occurred in 50 patients (5 PE, 48 proximal DVT) with no significant difference in frequency between subjects with retrieved and non-retrieved filters; one PE and one DVT occurred at 1 month and 1 week respectively after retrieval. Conclusion: Despite efforts to increase awareness of IVC filter-associated complications, the unweighted retrieval rate remained below the nationally reported average of 30%. Persistent risk factors for thrombosis such as active malignancy or increasing age and poor prognosis may play a role in the decision to defer retrieval. In our study, resumption of AC proved a powerful predictor of retrieval, with rates approaching expected values in this population. Active surveillance for resolution of contraindications to AC post-IVC filter placement is crucial in increasing retrieval rates. Figure Disclosures No relevant conflicts of interest to declare.

scholarly journals Prospective Study of an Inferior Vena Cava Filter Management Pathway in a Tertiary Care and Trauma Centre

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 685-685
Author(s):  
Erica A. Peterson ◽  
Paul R. Yenson ◽  
Jacobus C. Kritzinger ◽  
Lauren J. Lee ◽  
Jay Chi ◽  
...  
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Management Plan ◽  
Ivc Filter ◽  
Historical Cohort ◽  
Filter Retrieval ◽  
Filter Insertion ◽  
Lost To Follow Up

Abstract Background: In our institution, a retrospective analysis of inferior vena cava (IVC) filter usage demonstrated attempted removal in only 60% of patients. We performed a prospective cohort study to determine if an IVC filter management program (IVCFP) will improve retrieval rates. Methods: Consecutive patients receiving a retrievable IVC filter were approached for study enrollment within 48 hours of placement. Consenting patients received a visible “IVC Filter Identification Wristband” and pre-printed orders were placed in each patient's chart indicating that the wristband can only be removed by physician order if: 1) the filter has been retrieved; 2) a decision to make the filter permanent has been discussed and agreed upon with the patient; or 3) the patient has been referred to the Thrombosis Clinic for filter follow-up after hospital discharge. Educational pamphlets and Thrombosis Clinic referral information were provided to the patient and care team. All patients were followed up to time of hospital discharge and to the end of the study if the filter was still in situ. Baseline demographics, dates of filter insertion and retrieval, and data on filter indication, documentation of a follow-up plan, reasons for non-retrieval, and all-cause mortality were extracted from electronic and paper medical records using standard forms. The primary outcome was the proportion of patients who underwent attempted filter retrieval. Secondary outcomes included the proportion of patients who had a successful retrieval and documentation of a filter management plan. Results were compared with a historical cohort of 275 patients who had filters placed between Jan 2007 and Dec 2010. Group characteristics were compared using 2-sided t-tests for continuous variables and Chi-squared analysis for categorical variables. Results: Between Nov 2011 and Dec 2013, 92 of 111 eligible patients consented to participate. Mean age was 57.3 years and 67.4% were male. Compared to historical patients, IVCFP patients were more likely to be male (64.7% vs. 54.5%; p=0.03), less likely to have a prior history of venous thromboembolism (7.6% vs. 18.5%; p=0.01) and more likely to have received a filter for an acute VTE with contraindication to anticoagulation (76.1% vs. 72.4%; p=0.03) (see Table). At the end of study in June 2014, total length of follow-up for filter retrieval was 14,823 patient-days (median 48.5; range 4-956). No patient was lost to follow-up. Compared to historical data, the IVCFP significantly improved the proportion of patients with attempted retrieval (73/92 [79.3%] vs. 165/275 [60.0%]; p=0.001), documentation of an IVC filter management plan (91.3% vs. 73.8%; p<0.001) and successful retrieval (72.8% vs. 53.1%; p=0.001). Two patients in the IVCFP cohort and 28 historical controls did not have an attempted retrieval despite no clear reason for the filter to remain in situ permanently (2% vs. 10%; p=0.01). Of the 25 patients discharged with a filter in-situ, 20 were referred to our Thrombosis Clinic and 17 had a retrieval attempt post-discharge. Conclusions: Implementation of an IVCFP – consisting of a patient identification wristband, educational materials and referral for outpatient follow-up – was associated with significant increases in attempted filter retrieval and successful filter retrieval. The IVCFP represents an effective and low cost strategy to improve the follow-up and outcomes of patients receiving retrievable IVC filters. Table Historical Cohort N=275 Prospective Cohort N=92 P value Thrombotic risk factors, n (%) Acute VTE 213 (77.5) 78 (84.8) NS Prior VTE 51 (18.5) 7 (7.6) 0.01 Cancer 97 (35.3) 34 (37.0) NS Trauma 63 (22.9) 22 (23.9) NS Indications for filter insertion, n (%) Contraindication to AC 199 (72.4) 70 (76.1) 0.03 High risk for PE 31 (11.3) 10 (10.9) NS Primary prophylaxis 41 (14.9) 11 (12.0) NS Other 4 (1.5) 1 (1.1) NS Filter removal attempted, n (%) 165 (60.0) 73 (73.9) 0.001 Filter removal successful, n (%) 146 (53.1) 67 (72.8) 0.001 Documentation of a filter management plan, n (%) 203 (73.8) 84 (91.3) <0.001 Reasons for non-retrieval, n (%) Death in hospital/limited life expectancy 41 (14.9) 9 (9.8) NS Filter made permanent 22 (8.0) 4 (4.3) NS Persistent contraindication to AC 10 (3.9) 3 (3.3) NS High risk of PE despite AC 5 (1.8) 1 (1.1) NS Lost to follow-up 4 (1.5) 0 (0.0) NS Unknown 28 (10.2) 2 (2.2) 0.01 VTE, venous thromboembolism; PE, pulmonary embolism, NS, non-significant, AC, anticoagulation. Disclosures No relevant conflicts of interest to declare.

Perforation of inferior vena cava during filter placement

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 157-162 ◽  
Author(s):  
Piecuch ◽  
Wiewiora ◽  
Nowowiejska-Wiewiora ◽  
Szkodzinski ◽  
Polonski
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena Cava ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Retroperitoneal Hematoma ◽  
Ivc Filter ◽  
Filter Placement ◽  
Therapeutic Method

The placement of an inferior vena cava (IVC) filter is a therapeutic method for selected patients with deep venous thrombosis and pulmonary embolism. However, insertion and placement of the filter may be associated with certain complications. For instance, retroperitoneal hematoma resulting from perforation of the wall by the filter is such a very rare but serious complication. We report the case of a 64-year-old woman with perforation of the IVC wall and consecutive hematoma caused by the filter who was treated surgically.

scholarly journals Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population

2017 ◽  
Vol 44 (2) ◽  
pp. 179-189 ◽  
Author(s):  
Damian Everhart ◽  
Jamieson Vaccaro ◽  
Karen Worley ◽  
Teresa L. Rogstad ◽  
Mitchel Seleznick
Keyword(s):  
Managed Care ◽  
Inferior Vena Cava ◽  
Retrospective Analysis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Filter Placement

Duplication of the Inferior Vena Cava in a Patient Presenting for IVC Filter Placement

2010 ◽  
Vol 11 (2) ◽  
pp. 162-164 ◽  
Author(s):  
Danny Cheng ◽  
Steven M. Zangan
Keyword(s):  
Inferior Vena Cava ◽  
Protein C ◽  
Inferior Vena ◽  
Vena Cava ◽  
Factor V Leiden ◽  
Clinical Implications ◽  
Factor V ◽  
Ivc Filter ◽  
Protein C Deficiency ◽  
Filter Placement

Given the complex embryogenesis of the inferior vena cava (IVC), anatomic variations are commonly encountered. Duplication of the IVC occurs in up to 2.8% of the population. Though asymptomatic, a duplicated IVC has important clinical implications when attempting caval filtration. We present the case of a 45- year-old male with factor V leiden and protein C deficiency, who required cessation of warfarin anticoagulation in preparation for cervical laminectomy. The patient had a duplicated IVC and required placement of a caval filter in each IVC.

Supplemental Use of Inferior Vena Cava Filters: A Review of An Institutional Experience.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1279-1279
Author(s):  
Parminder Singh ◽  
Robert G. Lerner ◽  
Tarun Chugh ◽  
Hoang Lai ◽  
Wilbert S Aronov
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Thromboembolic Disease ◽  
Ivc Filter ◽  
Filter Placement ◽  
Ivc Thrombosis ◽  
Venous Thromboembolic ◽  
Post Filter

Abstract Introduction: Increasing use of inferior vena cava (IVC) filters in recent years as a preventative measure against pulmonary embolism (PE) has raised concern for usage outside of accepted guidelines. Based on the American College of Chest Physicians 2004 guidelines for the initial treatment of deep vein thrombosis (DVT) and PE, and the Eastern Association for the Surgery of Trauma 2002 guidelines for prophylaxis of PE, placement of an IVC filter is indicated in patients who either have, or are at high risk for thromboembolism, but have a contraindication for anticoagulation, a complication of anticoagulant treatment, or recurrent thromboembolism despite adequate anticoagulation. The purpose of our study is to identify patients who meet the guidelines for IVC filter placement and to compare clinical outcomes with those who did not meet the guidelines. Methods: Charts of 558 patients who received IVC filter placement were reviewed from Jan 1, 2004 to Dec 31, 2007. Patients were divided into two groups called within-guidelines or supplemental. The within-guidelines group included patients that met the criteria described above. The supplemental indication group included patients who did not have a contraindication or failure of anticoagulation. Patient characteristics and clinical outcomes between the two groups were compared and analyzed. Results: The within-guidelines group had 362 patients and the supplemental group had 196 patients. While there were more males in the within-guidelines group, age, race, length of stay, and in-hospital mortality were comparable between the two groups. Clinical follow-up in patients with a supplemental indication showed 1 (0.5%) case of post-filter PE, 2 (1%) cases of IVC thrombosis, 7 (3.6%) cases of DVT. Patients who were in the within-guidelines indication group had 4 (1.1%) cases of post-filter PE, 13 (3.6%) cases of IVC thrombosis, and 34 (9.4%) cases of DVT. All patients who developed post-filter PE had a prior DVT at the time of filter placement, and the risk of developing post-filter IVC thrombosis and PE is higher in patients with prior thromboembolic disease. Conversely, patients who did not have a VTE event before filter placement were at a significantly lower risk of developing IVC thrombosis and PE. Conclusion: Anticoagulation should be initiated at the earliest possible time in patients treated with an IVC filter to prevent subsequent venous thromboembolic disease. Our data does not support the use of IVC filter in patients who can tolerate anticoagulation and have no prior venous thromboembolic event due to the low risk of developing pulmonary embolism

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