Luminal Changes in Patients with Inferior Vena Cava Filters and Development of Chronic Venous Disease

Abstract

This study aimed to analyze the luminal changes in the iliocaval veins and their effects on the development of signs and symptoms of chronic venous disease manifesting from inferior vena cava (IVC) filter placement. This was a retrospective observations study; deidentified patients with an IVC filter placed with subsequent luminal changes were included. All patients had a computerized tomography (CT) scan with or without ultrasound and those who underwent an intervention for the obstruction had also venography and intravascular ultrasound (IVUS). The diameter of IVC and iliac veins was measured from the near wall to the far wall. IVC diameters measured less than 12mm were considered to be retractions. Signs and symptoms of chronic venous disease were obtained from patient charts and were reported according to the highest CEAP class. The data were analyzed using descriptive statistics, presenting diameter changes as a mean with standard deviation and a range of diameters included. Overall, 76 patients were included in this study, of whom 66 had occlusion of the IVC or the Iliac veins. Luminal changes of the IVC were observed in all patients. A total of 58 patients presented with chronic post-thrombotic changes in both the IVC and iliac veins. There were 4 patients that had a luminal reduction with no filling defects or post-thrombotic changes. Average IVC diameter and iliac vein diameter was measured to be 8.3±1.4mm and 4.6±1.4mm, respectively. Patients most frequently presented with extremity swelling, but other signs such as venous ulceration or skin damage were observed. Permanent luminal changes of the IVC and iliac veins were observed as a result of IVC filter placement and such patients commonly present with signs and symptoms of chronic venous disease. Together, with other known filter complications, these observations add more reasons for a timely retrieval. When such changes occur, patients' appropriate symptoms can be successfully treated. The permanent changes made by filter placement in the IVC and iliac veins further support filter retrieval in a timely fashion. The luminal changes induced by filter placement should be recognized early, particularly in symptomatic patients who can be safely treated with endovenous procedures.