Early Technical and Clinical Results with Retrievable Inferior Vena Caval Filters

Abstract

Deep venous thrombosis with or without subsequent pulmonary embolism is a common preventable cause of hospital death. Although anticoagulation is the accepted standard therapy for thromboembolic disease, in situations in which anticoagulation is contraindicated, interruption of the inferior vena cava (IVC) by means of percutaneous placement of a filter has become a widely used alternative. We report our initial experience with two retrievable IVC filters. Between July 2002 and April 2003, 13 patients (mean age 54 +/- 7 years; range 29-75 years) underwent percutaneous placement of either the Gunther Tulip (n = 5; Cook Inc., Bloomington, IN) or OptEase (n = 8; Cordis, Miami Lakes, FL) IVC filter. Five patients had filters placed prophylactically before major surgery. The remaining eight patients had had a contraindication to anticoagulation, and three had experienced a hemorrhagic complication as a result of anticoagulation following either a recently documented deep venous thrombosis (n = 3) or pulmonary embolism (n = 5). Filters were successfully placed in all 13 patients, with a duration of implantation ranging from 2 to 15 days. Retrieval was attempted in 12 patients (in 1 patient, permanent filtration was secondarily requested) and was achieved in 10 (84.6%) patients. In 2 patients, retrieval failure was due to device angulation within the vena cava precluding safe retrieval. In both instances, the device used was the Gunther Tulip filter. No patient developed symptomatic pulmonary embolism or insertion-site thrombosis following either filter deployment or removal. Trapped thrombus in the filters was seen in all patients. Retrieval required a mean of 6.8 minutes (range 5-10.2 minutes) of fluoroscopy time. Neither filter migration nor caval injury was observed. Temporary IVC filters are effective and are associated with a high retrieval success rate. Further study is warranted to determine the maximal duration of implantation and whether retrievable IVC filters should expand the indications for IVC filter placement.