Retrievable Inferior Vena Cava Filters Are Rarely Removed

2009 ◽  
Vol 75 (5) ◽  
pp. 426-428 ◽  
Author(s):  
Scott F. Gaspard ◽  
Donald J. Gaspard
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Retrospective Chart Review ◽  
Primary Data ◽  
Ivc Filter ◽  
Filter Placement ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Successful Removal

There has been an increasing nationwide trend of inferior vena cava (IVC) filter placement over the past 3 years. Most of these have been the newer, removable variety. Although these are marketed as retrievable, few are removed. The purpose of this study was to examine the practice pattern of IVC filter placement at Huntington Hospital. This study is a retrospective chart review of all IVC filter placements and removals between January 1, 2004, and December 31, 2006. The primary data points include indication for placement, major complications (migration, caval thrombosis, pulmonary embolus [PE]), attempted removal, and successful removal. Three hundred ten patients received IVC filters at our institution during this period. Eighty-four were placed in 2004, 95 in 2005, and 131 in 2006. Of those, only 12 (3.9%) were documented permanent filters, whereas the remainder (298) were removable. Of the retrievable filters placed, only 11 (3.7%) underwent successful removal. There were four (1.3%) instances in which the filter could not be removed as a result of thrombus present within the filter and two (0.67%) in which removal was aborted as a result of technical difficulty. Our use of IVC filters has increased steadily over the last 3 years. Despite the rise in use of “removable” filter devices, few are ever retrieved. Although IVC filter insertion appears an effective method of PE prevention, it comes at a cost, both physiological and monetary. It would be wise to devise more stringent criteria to identify those patients in the various populations who truly require filter placement and to be cautious in altering our indications for placement.

scholarly journals Safety and Outcomes of Permanent and Retrievable Inferior Vena Cava Filters in the Oncology Population

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Saba S. Shaikh ◽  
Suneel D. Kamath ◽  
Debashis Ghosh ◽  
Robert J. Lewandowski ◽  
Brandon J. McMahon
Keyword(s):  
Inferior Vena Cava ◽  
Cancer Patients ◽  
Inferior Vena ◽  
Vena Cava ◽  
Absolute Contraindication ◽  
Filter Placement ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Recurrent Vte ◽  
Clinically Significant

Background. The role for inferior vena cava (IVC) filters in the oncology population is poorly defined. Objectives. Our primary endpoint was to determine the rate of filter placement in cancer patients without an absolute contraindication to anticoagulation and the rate of recurrent VTE after filter placement in both retrievable and permanent filter groups. Patients/Methods. A single-institution, retrospective study of patients with active malignancies and acute VTE who received a retrievable or permanent IVC filter between 2009-2013. Demographics and outcomes were confirmed on independent chart review. Cost data were obtained using Current Procedural Terminology (CPT) codes. Results. 179 patients with retrievable filters and 207 patients with permanent filters were included. Contraindication to anticoagulation was the most cited reason for filter placement; however, only 76% of patients with retrievable filters and 69% of patients with permanent filters had an absolute contraindication to anticoagulation. 20% of patients with retrievable filters and 24% of patients with permanent filters had recurrent VTE. The median time from filter placement to death was 8.9 and 3.2 months in the retrievable and permanent filter groups, respectively. The total cost of retrievable filters and permanent filters was $2,883,389 and $3,722,688, respectively. Conclusions. The role for IVC filters in cancer patients remains unclear as recurrent VTE is common and time from filter placement to death is short. Filter placement is costly and has a clinically significant complication rate, especially for retrievable filters. More data from prospective, randomized trials are needed to determine the utility of IVC filters in cancer patients.

Indications for Inferior Vena Cava (IVC) Filter Placement - Assessing Compliance with Accepted Standards Set by Two Professional Societies

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2553-2553
Author(s):  
Amanjit S. Baadh ◽  
Stephen Rivoli ◽  
Jack Ansell ◽  
Robert E. Graham
Keyword(s):  
Internal Medicine ◽  
Interventional Radiology ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Filter Placement ◽  
Medical Specialties ◽  
Professional Societies ◽  
Ivc Filters

Abstract Abstract 2553 Background: Inferior Vena Cava (IVC) filter placement has increased significantly over the past few decades, due to expanding indications for filter placement. Indications for filter placement vary widely depending on which professional society recommendations are followed. Our objectives were to record the number of IVC filters placed in our medium sized metropolitan teaching hospital, assess the effect of medical specialty on placement and evaluate compliance with accepted standards as set by the American College of Chest Physicians (ACCP) and the Society of Interventional Radiology (SIR). Methods: Single-center, retrospective medical record review of all patients who received an IVC filter over 26 months (01/30/2008 - 4/5/2010). Inclusion criteria included patients from both sexes, all ages, filter placement within the aforementioned dates and inpatient procedures performed by interventional radiology. A total of 443 IVC filters were placed in our institution over the time period studied. 48.1% (213) of these filters were placed by interventional radiology. Of these, 187 were reviewed with 26 excluded do to incomplete patient records available at the time of review (July 2010). Medical records were reviewed for patient demographics, clinical course, and compliance with accepted guidelines set by the ACCP and SIR. Results: The average age was 75.3 years and 43.9% of the patients were males. 76.2% of patients were on the medical service (internal medicine and its subspecialties) whereas 22.8% were on non medical services. 87.2 % of filters were recommended by medicine and its subspecialties and 12.8% by non medical specialties. 43.3% of filters placed met guidelines established by the ACCP (Table 1). 79.1% of filters placed met SIR guidelines (Table 2). No documentation was available to assess compliance for 20.9% of filters. 46% of filters placed by internal medicine and its subspecialties met ACCP criteria whereas only 25% of filters recommended by non medicine specialties were compliant with criteria (p value=0.039, 95% CI). Physicians within internal medicine and its subspecialties were compliant with SIR guidelines for 84% of the filters placed, whereas only 46% of non medicine physicians met these indications (p=0.001, 95% CI). 35.8% of filters placed met SIR criteria but did not meet ACCP guidelines. Conclusions: Indications for IVC filter placement varied significantly in this study, less than half of filters placed met ACCP guidelines, yet over three-fourths met criteria set by the SIR, especially when comparing medicine and non medicine specialties. In analyzing the filters which meet indications set by SIR but not ACCP it becomes apparent that most of these are placed for patients classified as “fall risks”, failures of anticoagulation, limited cardiopulmonary reserve and medication noncompliance. Further research needs to be guided towards evaluating if these indications truly merit the placement of an IVC filter. This study strongly suggests a need for harmonization of current guidelines espoused by professional societies. A limitation of our study was that 230 filters placed by vascular surgery and interventional cardiology were not reviewed. Disclosures: No relevant conflicts of interest to declare.

Inferior Vena Cava Filter - Appropriate Use and Retrieval

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5912-5912
Author(s):  
Rena Shah ◽  
Anita Turk ◽  
Bilal Rahim ◽  
Waddah Arafat ◽  
Moniba Nazeef ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Conflicts Of Interest ◽  
Vena Cava ◽  
Complication Rates ◽  
Ivc Filter ◽  
Appropriate Use ◽  
Filter Placement ◽  
Ivc Filters ◽  
Retrievable Ivc Filters

Abstract Inferior vena cava (IVC) filters, first introduced in 1998, have been utilized to reduce risk of pulmonary embolism (PE) in the setting of an inability to anticoagulate patients. The use of IVC filters has increased and continues to rise, especially with the introduction of retrievable IVC filters. Since their initial introduction, guidelines have been developed on the appropriate use of IVC filters. According to the American College of Chest Physicians (ACCP), the use of an IVC filter is limited to patients with an absolute contraindication to therapeutic anticoagulation or failure or complication of anticoagulation in the setting an acute proximal venous thrombus. Relative indications for IVC filter placement include high clot burden in setting of low cardiopulmonary reserve, high risk patients, or severe trauma without documented thrombosis. In 2010, the FDA announced a safety communication recommending removal of retrievable IVC filters due to reports of several adverse clinical outcomes associated with retained filters including thrombus formation, recurrent PE, filter migration, erosion or perforation through the IVC wall, and filter fracture with fragment embolization. In 2014, the FDA recommended removal of the IVC filter within 2 months after filter placement if the patient's risk of thrombosis had passed. In this retrospective analysis of IVC filter management, we reviewed indications for placement according to current guidelines as set by the ACCP, initiation of appropriate anticoagulation, complication rates, and retrieval rates. In addition, we compared the data prior to the FDA recommendations in late 2014 and data after the recommendations to determine if there was a change in practice. After reviewing 179 patients, 89 patients in 2014 and 90 patients in 2015, who underwent IVC filter placement, only 81% (N=145) of patients had appropriate indications for IVC filter placement and 30% (N=54) of patients had inappropriate anticoagulation after IVC filter placement, given as prophylactic dosing of low molecular weight heparin. A comparison of retrieval rates prior to and after the FDA warning, showed a 19% (60% in 2014 vs 79% in 2015) improvement in IVC filter removals. There was an 11% complication rate, mainly related to IVC filter related acute DVT or IVC occlusion. A root cause analysis specifically for inappropriate IVC filter placement and appropriate anticoagulation and determined that familiarity of the guidelines and non-evidence based recommendations from consultants were major factors. Based on the analysis, we next plan to utilize the electronic health record system to help clinicians understand indications and when to initiate appropriate anticoagulation, with the opportunity for hematology consultants to be involved in situations that do not clearly fit within published guidelines. Disclosures No relevant conflicts of interest to declare.

scholarly journals Inferior vena cava filter – comprehensive overview of current indications, techniques, complications and retrieval rates

VASA ◽  
2020 ◽  
Vol 49 (6) ◽  
pp. 449-462 ◽  
Author(s):  
Xin Li ◽  
Ihab Haddadin ◽  
Gordon McLennan ◽  
Behzad Farivar ◽  
Daniel Staub ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Current Data ◽  
Ease Of Use ◽  
Ivc Filter ◽  
Comprehensive Overview ◽  
Filter Placement ◽  
Ivc Filters ◽  
Retrievable Ivc Filters

Summary: Inferior vena cava (IVC) filter has been used to manage patients with pulmonary embolism and deep venous thrombosis. Its ease of use and the expansion of relative indications have led to a dramatic increase in IVC filter placement. However, IVC filters have been associated with a platitude of complications. Therefore, there exists a need to examine the current indications and identify the patient population at risk. In this paper, we comprehensively reviewed the current indications and techniques of IVC filter placement. Further, we examined the various complications associated with either permanent or retrievable IVC filters. Lastly, we examined the current data on filter retrieval.

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 Retrievable Inferior Vena Cava Filters for Venous Thromboembolism

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Han Ni ◽  
Lei Lei Win
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Filter Placement ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Attractive Option ◽  
Venous Thromboembolic ◽  
Retrievable Ivc Filters

Inferior vena cava (IVC) filters are used as an alternative to anticoagulants for prevention of fatal pulmonary embolism (PE) in venous thromboembolic disorders. Retrievable IVC filters have become an increasingly attractive option due to the long-term risks of permanent filter placement. These devices are shown to be technically feasible in insertion and retrieval percutaneously while providing protection from PE. Nevertheless, there are complications and failed retrievals with these retrievable filters. The aim of the paper is to review the retrievable filters and their efficacy, safety, and retrievability.

scholarly journals Not so fast with the filter! Is it really in the inferior vena cava?

2020 ◽  
Vol 4 ◽  
pp. 20
Author(s):  
Jung Hyun Yun ◽  
Vinit Khanna ◽  
Rakesh Shewal Ahuja ◽  
Balasubramani Natarajan
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Percutaneous Nephrostomy ◽  
Ivc Filter ◽  
Filter Placement ◽  
Ivc Filters ◽  
Filter Loading ◽  
Lumbar Vein ◽  
The Right

Inferior vena cava (IVC) filter placement can lead to rare but sometimes serious complications, including malposition of the IVC filter in a non-target vessel or organ. We present the case of a 74-year-old male who presented to our institution for a percutaneous nephrostomy tube change and was incidentally found to have two IVC filters, one of which was properly positioned in the IVC and one of which was improperly deployed in the right ascending lumbar vein. Venography through the sheath before filter loading and deployment decreases the risk of malpositioning the IVC filter.

Inferior vena cava filters in cancer patients: indications and outcome.

1996 ◽  
Vol 14 (2) ◽  
pp. 652-657 ◽  
Author(s):  
R E Schwarz ◽  
A M Marrero ◽  
K C Conlon ◽  
M Burt
Keyword(s):  
Inferior Vena Cava ◽  
Cancer Patients ◽  
Inferior Vena ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Ivc Filter ◽  
Total N ◽  
Filter Placement ◽  
Long Term Outcome ◽  
Vena Cava Filters

PURPOSE Our experience with inferior vena cava (IVC) filter placement to prevent pulmonary emboli (PE) in cancer patients with deep vein thromboses (DVT) was reviewed to identify indications, patient characteristics, complications, and long-term outcome. METHODS Charts of 182 patients with cancer were retrospectively analyzed. All patients had received an IVC filter in our institution between January 1980 and April 1992. RESULTS Of 182 patients, 103 were men and 79 were women. Median age was 59 years (range, 15 to 88). Eight patients (4%) had stage I disease, 22 patients (12%) stage II, 37 patients (20%) stage III, and 115 patients (63%) stage IV. A DVT was diagnosed in 97 patients (53%), a PE in 46 patients (25%), and a combination in 39 patients (21%). Indications for IVC filter placement were DVT or PE in the presence of contraindications to anticoagulation therapy (perioperative, n = 58; CNS metastases, n = 20; thrombocytopenia, n = 7; bleeding, n = 61; others, n = 24; total, N = 170) or anticoagulation failure (recurrent PE, n = 6; recurrent DVT; n = 6; total N = 12). Filter placement complications (n = 6, 3%) included malposition (n = 3), migration (n = 1), arrhythmia (n = 1), and wound infection (n = 1), but no deaths. After filter placement, four patients developed a recurrent PE, and 11 patients developed a recurrent DVT. No significant postthrombotic complications were observed. CONCLUSION IVC filter placement patients with advanced cancer and thrombotic complications is safe, well tolerated, and can offer effective therapy/prophylaxis with a low incidence of treatment failure.

scholarly journals Case Report: Filtering the data on IVC filters

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 795
Author(s):  
Hina Khan ◽  
Usman Jilani
Keyword(s):  
Case Report ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Thromboembolic Disease ◽  
Ivc Filter ◽  
Filter Placement ◽  
First Line Therapy ◽  
Ivc Filters ◽  
Venous Thromboembolic

Venous thromboembolic disease is associated with high rates of morbidity and mortality. First line therapy for thromboembolic disease remains anticoagulation. However, certain populations warrant consideration of an inferior vena cava (IVC) filter. This case report discusses an example of a patient who presented with an acute pulmonary embolism and highlights the utilization of the inferior vena cava (IVC) filter as patient therapy. Thus, in this case report we will review the indications for IVC filter placement and compare the compliance of IVC filter placement to established guidelines of use.

scholarly journals Complications of Retrievable Inferior Vena Cava Filters: A Retrospective Comparison of Denali and Option-ELITE Filters

2018 ◽  
Vol 02 (03) ◽  
pp. 149-154
Author(s):  
Jessica Hightower ◽  
Richard Alexander ◽  
Evan Lehrman ◽  
Ryan Kohlbrenner ◽  
Nicholas Fidelman ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Filter Placement ◽  
Ivc Filters ◽  
Vena Cava Filters ◽  
Retrospective Comparison ◽  
Significant Difference ◽  
And Migration

Abstract Purpose To compare the complication rate of the Denali and Option-ELITE inferior vena cava (IVC) filters. Materials and Methods All patients who had a Denali or Option-ELITE IVC filter placed between March 2014 and March 2016 were retrospectively identified from the electronic medical records. Of the 245 IVC filters placed, the positions of 93 devices (21 Denali and 72 Option-ELITE) were documented on follow-up computed tomography (CT) examinations obtained for reasons unrelated to filter placement. In situations where multiple CT studies were obtained after placement, each study was reviewed, for a total of 200 examinations. Images were assessed for filter complication including caval wall penetration by filter components, associated damage to pericaval tissues, filter tilt, migration, and fracture. Results Penetration of at least one strut was observed in 13% of all filters imaged by CT, (Denali: 14%; Option-ELITE: 13%; p = 1.00). No patients had damage to pericaval tissues or documented symptoms attributed to penetration. Neither the Denali nor the Option-ELITE filters demonstrated significant tilt (> 15 degrees of tilt), migration, or fracture. Compared with Denali; the Option-ELITE filter demonstrated an increasing strut penetration rate with longer indwell times (z = –3.67, p < 0.01). Conclusions No significant difference was observed between the rates of caval penetration of the Denali and Option-ELITE IVC filters assessed by CT. Additionally, no findings of filter fracture or migration were noted, suggesting that the Denali filter is non-inferior to the Option-ELITE filter with respect to penetration, fracture, tilt, and migration. The Option-ELITE filter demonstrated a time-dependent tendency toward greater strut penetration with longer indwell times.

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