Inferior vena cava filter placement during thrombolysis for acute iliofemoral deep venous thrombosis.

Abstract

The objectives of this study were to evaluate the need for inferior vena cava (IVC) filters and to identify anatomic and patient-specific risk factors associated with embolization in patients undergoing thrombolysis for acute iliofemoral deep venous thrombosis (DVT). Consecutive patients who underwent catheter-directed thrombolysis or pharmacomechanical thrombolysis (PMT) for iliofemoral DVT from May 2007 toMarch 2012 were identified from a prospectively maintained database. Patients were categorized in two groups, depending on the status of IVC filtration during the lysis procedures: patients with an IVC filter protection (group A) and patients without an IVC filter protection (group B). The primary outcome was perioperative clinically significant pulmonary embolism (PE) or intraprocedural IVC filter clot capture. Eighty patients (mean age, 50± 16years; 39 women) with symptoms averaging 12± 10days were treated. A perioperative IVC filter was placed in 32 patients, and nine patients had an indwelling patent filter (group A, n= 41). Twenty patients received no filter, and 19 patients had an indwelling thrombosed filter (group B, n= 39). There were no clinically significant PE in either group. In group A, nine patients (22%) had documented embolic clot within the filter nest. The clot volume was deemed clinically significant in only two patients (5%). Factors related to embolization included female gender (odds ratio [OR], 5.833; 95% confidence interval [CI], 1.038-32.797; P= .032) and preoperative clinical PE (OR, 5.6; 95% CI, 1.043-30.081; P= .054). A trend for increased embolization was seen with a higher average number of DVT risk factors(1.44 vs 1; P= .065) and when PMT was used as a single treatment (OR, 4.32; 95% CI, 0.851-21.929; P= .087). IVC filters during thrombolysis should be used selectively in patients with preoperative clinical PE, in women and potentially in patients with multiple risk factors for DVT, or when stand-alone PMT is planned.