IVC filter

Background

  • not meant to treat anything, just prevent PE
  • >10 differents filters now in use
  • most new ones are retrievable
  • recent marked increase in IVC filter use (since 2003 introduction of retrievable filters)
  • prophylactic filter uses expanding in spinal surgery, bariatric surgery and percutaneous endovenous intervention

Indications

American College of Chest Physicians (ACCP)

  • acute proximal DVTor PE where anticoagulation not possible because of bleeding risk (Grade 1B)
  • acute DVTin children with contraindication to anticoagulation (2C)
  • selected patients with DVT/PE despite adequate anticoagualation
  • recommend AGAINST placing filter in severe trauma patients for primary VTE prophylaxis (2C)
  • recommend AGAINST placing in major ortho surgery for primary VTE prophylaxis (2B)
  • recommned AGAINST placing filter and anticoagulation for high risk patients with documented DVT/PE (1B)

Eastern Association for the Surgery of Trauma (EAST) Guidelines

differ from ACCP guidelines in recommend IVC filter for trauma patients immobilized for prolonged period:

  • severe closed head injury (GCS<8)
  • spinal cord injury (paraplegia, quadriplegia)
  • complex pelvic fractures with long bone fractures
  • multiple long bone fractures

Complications

Early

  • puncture site hematoma
  • malposition or tilting of device
  • delivery system complications (guidewire mishap)
  • failure to open completely

Late

  • many retrievable IVC filters are placed with no systems mechanism for the timely removal placing patients are increased risk of delays complications:
  • tilting of device (making it less effective)
  • migration of filter (to SVC or heart)
  • fracturing of structs with embolization
  • IVC perforation
    • retroperitoneal hematoma
    • aortic pseudoaneurysms
    • duodenal perforation
    • penetration of pancreas, iliopsoas, vertebral body

Evidence Based Outcomes

  • the one randomized controlled study of IVC filters failed to show a mortality difference (out to 8yrs), although the IVC filter group did have a lower incidence of PE
  • A clinical trial of vena cava filters in the prevention of pulmonary embolism in patients with proximal deep vein thrombosis. N Engl J Med. 1998 Feb 12;338(7):409-15

See Also

References

  • Rogers FB et al. Venous Thromboembolism: Role of Vena Cava Filters in Prophylaxis and Treatment of Pulmonary Embolism. J Trauma. 53(1):142-162;2002
  • Guyatt GH et al. Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141:7-47.
  • A clinical trial of vena cava filters in the prevention of pulmonary embolism in patients with proximal deep vein thrombosis. N Engl J Med. 1998 Feb 12;338(7):409-15

Authors:

Ross Donaldson