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