Structured team-oriented program to follow patients after vena cava filter placement: a step forward in improving quality for filter retrieval

Salah D Qanadli,Laurence Crivelli,Kiara Rezaei-Kalantari,Anne-Marie Jouannic,David C Rotzinger,Francesco Doenz

doi:10.1038/s41598-021-82767-3

Abstract

To reduce inferior vena cava filter (IVCF) related complications, retrieval is recommended whenever possible. Nevertheless, IVCF retrieval rates remain lower than expected, likely due to insufficient follow-up after placement. We evaluated the value of a structured program designed to follow patients by the interventional radiology team up to 5 months after IVCF placement. We prospectively enrolled 366 consecutive patients (mean age 64 ± 17 years; 201 men and 165 women) who benefited from IVCF between March 2015 and February 2020. The program consisted of advising the patient and clinicians to consider IVCF retrieval as soon as possible (standard workflow) and systematically planning an additional follow-up visit at 5-month. Clinical and technical eligibility, as well as technical success for retrieval (TSR) were evaluated. At 5-months, 38 (10.4%) patients were lost to follow-up, and 47 (12.8%) had died. Among survivors, the overall retrieval rate was 58%. The retrieval rates were 83% and 97% for the clinically eligible and technically eligible patients for retrieval, respectively. The 5-month visit enabled 89 additional retrievals (47.8%) compared to the standard workflow. No significant difference was seen in TSR before and after 5 months (p = 0.95). Improved patient tracking with a dedicated IVCF program results in an effective process to identify suitable patients for retrieval and drastically improves retrieval rates in eligible patients. Involving interventionalists in the process improved IVCF patient management.

Highlights

To reduce inferior vena cava filter (IVCF) related complications, retrieval is recommended whenever possible
A recent study conducted in patients with cancer-associated venous thromboembolism who received an IVCF confirmed the absence of significantly different all-cause mortality, but showed a lower pulmonary embolism (PE)-related m ortality[5]
The rationale for temporary filtration is based on well-founded concerns regarding long-term complications of permanent IVCFs, in young patients with a temporary contraindication for anticoagulation

Summary

Introduction

To reduce inferior vena cava filter (IVCF) related complications, retrieval is recommended whenever possible. The program consisted of advising the patient and clinicians to consider IVCF retrieval as soon as possible (standard workflow) and systematically planning an additional follow-up visit at 5-month. Up to 17% of patients with PE receive an IVCF1 Despite their frequent use, the indications for, clinical benefits, and long-term outcomes of IVCF use are regularly a matter of debate and concern, resulting in non-standardized guidelines and sometimes conflicting recommendations[2]. A recent study conducted in patients with cancer-associated venous thromboembolism who received an IVCF confirmed the absence of significantly different all-cause mortality, but showed a lower PE-related m ortality[5]. IVCF use is associated with multiple mechanical complications, mostly with long-term u se[3] These limitations justified the promotion of temporary filtration and retrieval of the filtration device as soon as possible. The main reason is a lack of follow-up after filter placement and failure to inform patients regarding the benefits of retrieving the filter if p ossible[3,14]

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Conclusion