Inferior Vena Cava Filter Retrieval Trends: A Single-Center Experience.

Leann M Blankenship,Nwabundo Anusim,Michael Stender,Filip Ionescu,Ishmael Jaiyesimi,Lihua Qu,Eva Ma

doi:10.1055/s-0040-1722707

Leann M Blankenship, Nwabundo Anusim + Show 5 more

Open Access

https://doi.org/10.1055/s-0040-1722707

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Abstract

Recognition of the adverse events of inferior vena cava filters (VCFs) has prompted the Food and Drug Administration (FDA) to issue safety warnings (2010 and 2014), advocating for removal, once the risk of pulmonary embolism has abated. Despite an initial increase in retrieval rates, these remain low (25–30% at 1 year in 2014). We retrospectively investigated retrieval trends in adults with VCFs placed between 2015 and 2018 at a single institution. The rate of retrievable VCF removal accounting for the competing risk of death was the main outcome. There were 494 VCFs placed (305 retrievable). The cumulative incidence of retrieval remained low (21% at 1 year), even after the second FDA warning (2014). Patients who resumed anticoagulation (AC) at any time were more likely to have retrieval (hazard ratio [HR] = 3.6, p < 0.01) and had higher retrieval rates at every time point (31.4 vs. 7.6% at 1 year). Advanced age (HR = 0.98 per year, p = 0.004), stroke (HR = 0.28, p = 0.028), and active malignancy (HR = 0.42, p = 0.006) predicted nonretrieval. Device-related complications were infrequent (<1%) but thrombotic complications occurred early and were more common for nonretrieved VCFs (17 vs. 12%, p = 0.29). Revision of guidelines to recommend active surveillance for the ability to tolerate AC in the immediate postimplantation period may improve retrieval rates.

Highlights

Inferior vena cava filters (VCFs) are devised to mechanically prevent embolization to the pulmonary circulation of thrombi formed in the venous systems of the pelvis and of the lower extremities
We retrospectively investigated retrieval trends in adults with VCFs placed between 2015 and 2018 at a single institution
Complications were divided into device-related and thrombotic (deep vein thrombosis [DVT] and Overall Vena Cava Filter Population Over 3 years, 494 VCFs were placed at our institution (305 [62%] were retrievable). ►Fig. 1 provides an outline of the study population

Summary

Introduction

Inferior vena cava filters (VCFs) are devised to mechanically prevent embolization to the pulmonary circulation of thrombi formed in the venous systems of the pelvis and of the lower extremities. Filter utilization has increased in the United States and Europe with the advent of retrievable VCFs,[8,9] raising concerns regarding VCF safety,[10] which have prompted the U.S Food and Drug Administration (FDA) to issue two device safety warnings in 2010 and received March 30, 2020 accepted after revision December 10, 2020.

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