Evaluation of inferior vena cava filter placement during percutaneous endovenous intervention for proximal lower extremity deep venous thrombosis: a retrospective study

Abstract

Background Anticoagulant therapy is still the prevalent treatment for venous thromboembolism. In the new era of percutaneous endovenous intervention, there is a progressive increase in the use of percutaneous endoluminal clot dissolution techniques such catheter-directed thrombolysis (CDT) and mechanical aspiration thrombectomy devices because of their short-term advantages. Prophylactic deployment of inferior vena cava (IVC) filter during percutaneous endovenous therapy for lower extremity deep venous thrombosis (DVT) is still a debatable issue. Objectives The aim of our study is to assess retrospectively the frequency of embolization and the need for deployment of a retrievable IVC filter during endovenous treatment of proximal lower extremity DVT using percutaneous CDT and AngioJet pharmacomechanical thrombectomy (PMT) techniques. Settings and design This was a retrospective study. Patients and methods Percutaneous endoluminal clot dissolution using either CDT or AngioJet PMT for proximal lower extremity DVT was performed on 56 patients (59 limbs) of 187 patients diagnosed with proximal acute/subacute DVT in the Vascular Surgery Department of the study hospitals. An IVC filter was deployed in 29 patients before or during the procedure. Results Of 56 patients who were treated for proximal DVT with clot debulking procedures, the IVC filter was prophylactically deployed in 26 (46.4%) patients. Trapped thrombus in the deployed filters as shown on venocavography was observed in 9/26 (34.6%) filters deployed prophylactically, with an overall rate of thrombus embolization during percutaneous endovenous thrombus dissolution techniques being 12/56 (21.4%) patients. Conclusion CDT could be performed safely and effectively without routine prophylactic IVC filter placement in the treatment of acute DVT. Selective filter placement may be considered in patients undergoing PMT or patients with more proximal thrombus patterns with multiple risk factors.