PC190. A Quality Improvement Project to Improve IVC Filter Retrieval

Abstract

Poor retrieval rates for retrievable inferior vena cava filters (R-IVCFs) have been reported throughout the literature, with poor follow-up as common cause. In 2009, we reported a retrieval rate of 18% despite an initial follow-up rate of 85%. Use of a registry has been shown to improve retrieval rates. In May 2012, as a process improvement project for Accreditation Council for Graduate Medical Education (ACGME) requirements, the vascular surgery fellowship implemented a reiterative registry to track R-IVCFs placed at Walter Reed National Military Medical Center to improve retrieval rates. We reported the initial 6-month results for 28 patients at the 2013 Winter Meeting of the Vascular and Endovascular Surgery Society. Here we report the results after 32 months with a total of 115 patients. Patients receiving R-IVCF were entered into a registry. All patients were reviewed monthly using an electronic health record (EHR). When there were no longer indications for R-IVCF, the patient was scheduled for an outpatient appointment with a vascular surgeon and then retrieval. Rates of retrieval, technical success, dwell time, indication, complications, and demographics were calculated for filters placed between May 2012 and January 2015. A total of 115 R-IVCFs were placed between May 2012 and January 2015. Fifty filters were placed for therapeutic indications and 65 for prophylactic indications. Our follow-up rate improved to 95%. A total of 72 filters were retrieved (63% absolute retrieval rate). The average dwell time was 103 days (range, 7-460 days), and 62% were retrieved within 3 months of placement. Technical success for retrieval was 91%. There were two major complications from retrievals (2.5% of retrievals). The creation of R-IVCF registry promoted on-going follow-up with patients. In our earlier experience, retrieval rates were poor despite a high follow-up rate. The use of a reiterative registry improved our retrieval rate by 45% and increased our follow-up rate to 95%. These results emphasize the importance of repetitive follow-up for R-IVCF. Despite follow-up, nearly a third of R-IVCF are not retrieved.