Temporary and Permanent Inferior Vena Cava Filters in the Oncology Population

Abstract Background The use of both temporary and permanent inferior vena cava (IVC) filters continues to rise yet randomized data regarding efficacy and complication rates are limited, especially in cancer patients. Temporary IVC filters are associated with higher costs and can have more long-term complications than permanent IVC filters. In this study, we examined the use of temporary and permanent IVC filters in the cancer population, a group at high risk for venous thromboembolism (VTE) as well as complications of anticoagulation. Methods This single-institution study included patients with active malignancy receiving adjuvant chemotherapy or considered for future chemotherapy that received an interventional radiology (IR) placed temporary (N=179) or permanent (N=207) IVC filter from 2009 to 2013. Patients were followed prospectively from the time of filter placement. The database included patient demographics, type of malignancy, indication for filter placement, time to filter retrieval, complications of placement/retrieval, rates of VTE recurrence and cause of death (if applicable). Results Patient demographic information is shown in Table 1. The most common reasons cited for filter placement included a contraindication to anticoagulation from bleeding (36%), recent or upcoming procedure (19%), thrombocytopenia (17%), and surgical prophylaxis (8%). 21% of filters were placed in patients with no contraindication to anticoagulation or failure of anticoagulation. Of these, 35% of the temporary filters were not removed. IVC filters were most frequently placed in patients with underlying hematologic malignancies (22%), gastrointestinal malignancies (22%) and lung cancer (16%). The majority of patients had stage III or IV cancer (62%). Of the 179 temporary filters placed, 60% were not retrieved. The most common reasons for failure of filter retrieval included: progressive disease/clinical deterioration (51%), continued contraindication to anticoagulation (23%) and loss of follow-up (8%). Only 2% of filters could not be removed because of mechanical reasons. Of the 81 attempted filter removals, 5 had in-filter thrombus, 4 had surrounding fibrin sheaths, 4 had filter tilt, 1 had IVC in-growth, 1 had broken struts and 1 had a procedure-related infection. The rate of recurrent VTE in all patients studied was 23% (21% in temporary filter group, 24% in permanent filter group), including 20 pulmonary emboli (PE) and 14 thromboses within the IVC filter. The majority of recurrences occurred off of anticoagulation (58%). Only 34% could be maintained on therapeutic anticoagulation. By study end, 72% of patients had died, most commonly due to progressive cancer. Median time from filter placement to death was 2.9 months (range: 0.1-64.7 months). Seventy-five patients (19%) died within 30 days of filter placement. They were more likely to have stage IV disease (78% vs. 54%). Of these 75 patients, three experienced recurrent VTE, two with lower extremity DVTs and one with an IVC thrombus. Data on filter costs were also collected. Costs were attributable to the placement and retrieval procedures when applicable ($10,983.00 and $8,824.00, respectively) as well as the device itself ($1,576.00). Conclusions Malignancy-associated thrombosis is common and associated with a high rate of recurrence. While most recurrent VTE after IVC filter placement were deep vein thromboses, a relatively large number of PE's occurred after filter placement as well. A significant number of patients with malignancy-associated thrombosis who underwent IVC filter placement had no contraindication to anticoagulation or recurrent VTE while on anticoagulation. Better prospective studies are needed to assess the safety and efficacy of IVC filters in the setting of hemodynamic compromise, extensive clot burden or for surgical prophylaxis, especially in the oncology population. In this cohort, the majority of filters were placed in patients with advanced cancer with likely short life expectancies, suggesting the patient selection for filter placement could be optimized. Finally, the cost of filter placement and retrieval is substantial, further emphasizing the need for better prospective data to identify the subset of patients who will derive the most benefit from filter use. Disclosures Stein: Incyte Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding. Lewandowski:Cook Medical: Consultancy; Boston Scientific: Membership on an entity's Board of Directors or advisory committees.

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A New Catheter Technique to Correct Severe IVC Filter Tilt during Placement

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-3401346 ◽

2019 ◽

Vol 4 (01) ◽

pp. 27-30

Author(s):

Sandeep T. Laroia ◽

Justin J. Guan ◽

Archana T. Laroia ◽

Lucas Lenhart ◽

Antony J. Hayes

Keyword(s):

Inferior Vena ◽

Vena Cava ◽

Complication Rates ◽

Ivc Filter ◽

Filter Placement ◽

Femoral Access ◽

Catheter Technique ◽

Ivc Filters ◽

Catheter Tip ◽

A Minor

Abstract Introduction Inferior vena cava (IVC) filter tilt is a common complication that occurs during and after filter placement. Severe tilting leads to reduced filter efficacy, lower retrieval success, and higher complication rates during retrieval. We present a novel catheter technique to correct severely tilted cone-shaped IVC filters without having to retrieve and replace the existing filter. Methods A retrospective review was performed for patients at our institution over three years who had severely tilted filters and underwent correction with the catheter technique. Indications for filter placement were categorized, and patient age, gender, tilt correction outcome, and complication rates were collected and analyzed. After severe tilting was noted on post-IVC filter deployment venogram, a Sos catheter was passed via the same femoral access site used for the filter placement. The catheter tip was reformed inside the cone of the filter and was used to push the filter tip back toward midline. Completion venogram was taken to document the amelioration of the tilt. Results Out of 28 patients who were found to have severely tilted filters on deployment and underwent correction with the catheter technique, 27/28 (96.4%) had successful correction. One (3.6%) had a minor complication where the filter struts became entangled with the catheter tip; however, simple maneuvering of the catheter and use of a stiff wire to straighten the catheter loop freed up the entanglement. No major complications occurred. Conclusion This technique is safe, effective, obviates filter replacement, and can be considered an additional management option for severe IVC filter tilt during placement.

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

International Journal of Vascular Medicine ◽

10.1155/2020/6582742 ◽

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.

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Prophylactic placement of an inferior vena cava filter in high-risk patients undergoing spinal reconstruction

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.4.6 ◽

2004 ◽

Vol 17 (4) ◽

pp. 1-6 ◽

Cited By ~ 54

Author(s):

Michael K. Rosner ◽

Timothy R. Kuklo ◽

Rabih Tawk ◽

Ross Moquin ◽

Stephen L. Ondra

Keyword(s):

Pilot Study ◽

High Risk ◽

Inferior Vena ◽

Vena Cava ◽

Ivc Filter ◽

Matched Cohort ◽

Filter Placement ◽

High Risk Patients ◽

Ivc Filters ◽

Risk Patients

Object The purpose of this study was to evaluate the safety and efficacy of prophylactic inferior vena cava (IVC) filter placement in high-risk patients who undergo major spine reconstruction. Methods In the pilot study, 22 patients undergoing major spine reconstruction received prophylactic IVC filters. These patients were prospectively followed to evaluate complications related to the filter, the rate of deep venous thrombosis (DVT) formation, and the rate of pulmonary embolism (PE). These data were compared with those obtained in a retrospective review for PE in a matched cohort treated at the same institution. At a second institution the treatment guidelines were implemented in 17 patients undergoing complex spine surgery with the same follow-up criteria. In the pilot study, no patient experienced PE (0%), whereas two had DVT (9%). Bilateral DVT developed postoperatively in one patient (associated morbidity rate 4.5%), who required thrombolytic therapy. One patient died of unrelated surgical complications. The PE rate in the matched cohort at the same institution was 12%. At the second institution, no patient had PE, and no complications were noted. Conclusions In this patient population, prophylactic IVC filter placement appears to decrease the PE rate substantially, from 12 to 0%. The placement of IVC filters appears to be a safe and efficacious intervention for prevention of PE in high-risk patients.

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Temporary Vena Cava Filters in Oncology Patients

Blood ◽

10.1182/blood.v124.21.4247.4247 ◽

2014 ◽

Vol 124 (21) ◽

pp. 4247-4247

Author(s):

Elizabeth H Cull ◽

Robert Lewandowski ◽

Brady L Stein ◽

Brandon McMahon

Keyword(s):

Cancer Patients ◽

Vena Cava ◽

Ivc Filter ◽

Prospective Data ◽

Gastrointestinal Malignancies ◽

Filter Placement ◽

Advanced Malignancy ◽

Ivc Filters ◽

Recurrent Vte

Abstract Background While inferior vena cava (IVC) filter placements continue to exponentially increase, the long-term complications from these devices are progressively more recognized. Randomized data on the efficacy of filters is sparse and focuses mainly on outcomes following permanent filter placement; however, the majority of filters placed currently are retrievable. Placement and removal of these filters are more expensive than permanent filters and have more long-term complications. In this study, we analyzed the use of retrievable filters in the cancer population, a group at very high risk for incident and recurrent venous thromboembolism (VTE). Methods This is a single-institution study. All patients with a history of malignancy or active malignancy that received an interventional radiology (IR) placed temporary IVC filter from 2009 to 2013 were logged into a database. Patients were followed prospectively from time of device placement. Recorded data included demographics, type of malignancy, indication for filter placement, time to filter retrieval, complications of placement/retrieval, rates of VTE recurrence and cause of death (if applicable). Final data analysis (n=179 filter placements) was only performed on patients that had an active malignancy or were receiving adjuvant therapy for a recent active malignancy. Results The most common indications cited for filter placement included a contraindication to anticoagulation (69%), surgical prophylaxis (17%) and concern for cardiopulmonary collapse from a pulmonary embolism (PE) (6%). IVC filters were most frequently placed in patients with underlying hematologic malignancies (28%), gastrointestinal malignancies (17%) and gynecologic malignancies (15%). The majority of patients had stage III or IV cancer (61%). Internal medicine providers were most likely to order filter placements (36%) followed by hematologists/oncologists (26%) and gynecologic oncologists (17%). 35% of filters were not placed due to a contraindication to anticoagulation or failure of anticoagulation, and of these filters placed, 20% were not removed. Of the 179 temporary filters placed, 60% remained permanent. The most common reasons stated for failure of filter removal included: progressive disease/clinical deterioration (51%), continued contraindication to anticoagulation (23%) and loss of follow-up (7%). Only 2% of filters were unable to be removed because of mechanical reasons. Of the 81 attempted filter removals, 5 had in-filter thrombus, 4 had surrounding fiber sheaths, 4 had filter tilt, 1 had IVC in-growth, 1 had a procedure related infection and 1 had broken struts. The rate of recurrent VTE in all patients studied was 20% (predominantly deep vein thromboses), with the majority of recurrences occurring in patients that had the filter in place and were not maintained on anticoagulation. By the end of the study, 59% of patients had died, most commonly due to progressive cancer. Median time from filter placement to death was 5.25 months. Additionally, we gathered data on filter costs. Costs were attributable to the device ($1576.00), placement ($10,983.00) and removal ($8,824.00), totaling over $2 million dollars for placement of IVC filters in this cohort. Conclusions A significant number of cancer patients who have an IVC filter placed have no contraindication to anticoagulation or evidence of recurrent VTE on anticoagulation. Better prospective data is needed regarding the safety and efficacy of IVC filter placement for prophylactic purposes or in the setting of a large VTE burden as these are commonly cited indications for placement. Additionally, consideration for permanent filter placement should be made in cancer patients as the majority of temporary filters are not removed and may carry higher risks of complications. Notably, our filter removal rate was significantly higher than the retrieval rate at most centers (<20%). IVC filters are commonly placed in patients with advanced malignancy and low expected survival, raising particular questions regarding their role in this patient population. Finally, the cost of filter placement and removal is markedly high, further emphasizing the need for better prospective data to clearly delineate those patients who will derive the most benefit from their use. Disclosures Lewandowski: Cook Medical: Consultancy; Boston Scientific: Membership on an entity's Board of Directors or advisory committees. Stein:Incyte Corporation: Honoraria, Speakers Bureau; Sanofi Oncology: Honoraria.

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

Blood ◽

10.1182/blood.v116.21.2553.2553 ◽

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.

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Inferior Vena Cava Filter - Appropriate Use and Retrieval

Blood ◽

10.1182/blood.v128.22.5912.5912 ◽

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.

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

VASA ◽

10.1024/0301-1526/a000887 ◽

2020 ◽

Vol 49 (6) ◽

pp. 449-462 ◽

Cited By ~ 1

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.

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Inferior Vena Cava Filter Retrieval Trends: A Single Center Experience

Blood ◽

10.1182/blood-2019-129366 ◽

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.

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Exploring Patient-Related Facilitators and Barriers of Inferior Vena Cava Filter Retrieval

Blood ◽

10.1182/blood.v124.21.3524.3524 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3524-3524

Author(s):

Anita Rajasekhar ◽

Jordan Neil ◽

Joseph Pittman ◽

Rebecca Beyth

Keyword(s):

Inferior Vena Cava ◽

Board Of Directors ◽

Inferior Vena ◽

Vena Cava ◽

Adult Patients ◽

Advisory Committees ◽

Ivc Filters ◽

Vena Cava Filters ◽

Facilitators And Barriers

Abstract Introduction: While the majority of retrievable inferior vena cava filters (rIVCFs) are candidates for retrieval once the risk of thrombosis or bleeding has subsided, only ~ 20% of IVCFs are retrieved. Lack of patient follow-up is cited as the primary contributor to low retrieval rates. However, studies have not examined patient-perceived factors that lead to poor follow-up. Methods: This is a single center cross-sectional mixed methods study. Adult patients who received a rIVCF at our institution from 2008-2011 were included. Patients were excluded if it was decided to leave the IVCF in permanently. Eligibles were dichotomized into IVCF retrieved (R) versus not-retrieved (NR). A random sample of 100 patients (50 per group) was contacted for an individual face-to face interview. Target enrollment was 35 patients per group until thematic saturation was reached. The healthcare decision maker (HCDM) was invited to the interview if he/she provided consent to have the IVCF placed. Individual interviews were conducted by a hematologist and a health communications expert. Interviews focused on predisposing, enabling, reinforcing, situational, and procedural-related factors that may have affected IVCF retrieval. Transcripts of the interviews were analyzed by a multi-disciplinary team to identify and consolidate impressions into a list of themes elucidating facilitators and barriers to IVCF retrieval. Transcripts were coded according to finalized themes utilizing a cross-platform application for analyzing qualitative data. Results: 808 adult patients who received an IVCF at our institution from 2008-2011 were identified (R= 146, NR= 658). Thematic saturation was reached after the first fifteen interviews (8R and 7NR). 33.3% of subjects had a HCDM that consented for IVCF placement. 66.7% were male; 60% of IVCFs were placed for primary VTE prophylaxis despite only 26.7% having a contraindication to anticoagulation at the time of placement, 53.3% were placed by interventional radiology and 46.7% by vascular surgery, 53.5% had an IVCF placed during an admission for trauma; 40% had a history of prior VTE. The average time from hospital admission to IVCF placement was 3.7 days. Of the 8 patients that had their IVCF retrieved, the average time to retrieval was 279 days. Commonly expressed themes associated with retrieval or non-retrieval are depicted in Table 1. Conclusion: This study is unique in that it explores patient-related facilitators and barriers to IVCF retrieval. Preliminary results indicate that differences in themes expressed by patients may contribute to likelihood of retrieval. Results from this study will be used to develop and prospectively pilot a patient-centered educational resource toolkit for patients with IVC filters to enhance shared-decision making and overcome obstacles to IVCF retrieval. Table 1 Table 1. Common patient-perceived themes and subthemes Disclosures Rajasekhar: Anticoagulation Forum/Boston University: Speakers Bureau; Alexion: Membership on an entity's Board of Directors or advisory committees; Baxter: Membership on an entity's Board of Directors or advisory committees; Octapharma: Membership on an entity's Board of Directors or advisory committees.

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

American Journal of Interventional Radiology ◽

10.25259/ajir_29_2020 ◽

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.

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