Patterns of use and outcome of inferior vena cava filters in a tertiary care setting.

Abstract

Inferior vena cava (IVC) filter placement is increasing although the evidence to justify their use is limited. Many filters are left in place indefinitely, thereby exposing patients to long-term complications. To review indications, complications, and follow-up data of patients undergoing IVC filter placement at our center. A retrospective review of consecutive admitted patients who underwent IVC filter insertion in a large university hospital with a level I trauma center. Thrombosis specialists retrospectively assessed the appropriateness of indication for IVC filter placement as well as referral for retrieval. Overall, 405 filters were inserted between 2009 and 2013. All filters were retrievable. IVC filter was placed as a primary prevention in 42% of patients. Fifty-two patients (12.8%) experienced at least one filter-related complication. The most common complication was deep vein thrombosis occurring in 6.9% of cases. Almost a third of all complications occurred in filters originally placed for prophylactic indications. Only 13.6% of filters were successfully removed. Nevertheless, according to our reviewers, an attempt for filter retrieval should have been made in 57% of all cases and in 86% of trauma patients. A significantly higher retrieval rate was found in patients followed at our thrombosis clinic (P<0.01). During follow-up, 95 patients (23.4%) died, most of them with active cancer. IVC filters are placed in many cases for prophylactic indications. Their low retrieval rates together with relatively high risk of long-term complications, questions their extensive utilization. Prospective trials addressing the safety and efficacy of IVC filters are still warranted.