The Use of Inferior Vena Caval Filters Prior to Major Surgery in Women With Gynaecological Cancer

Abstract

Perioperative venous thromboembolism (VTE) is relatively frequent in women with gynecological cancer, making surgery a challenge. Delaying surgery for a month or longer may not be appropriate, while maintaining full anticoagulation creates a risk of perioperative bleeding. At the same time, stopping anticoagulation will increase the risk of recurrent VTE and pulmonary embolism. Another option is to insert an inferior vena cava filter (IVCF) to prevent lower-limb and pelvic thrombi from reaching the pulmonary arteries. Filters usually are placed below the renal veins to prevent renal vein thrombosis as well. They may be inserted through the femoral vein or via the transjugular route. This retrospective review analyzed outcomes in 39 women having both gynecological malignancy and VTE who had an IVCF placed before major abdominal surgery in the years 1996-2006. Thirty-five of the women had primary, and 4 recurrent disease. Ovarian and uterine cancers were most frequent. Indications for filter placement included a history of pelvic/leg deep vein thrombosis and/or pulmonary embolism. Both permanent and retrievable filters were inserted, the latter most commonly in younger women. No morbidity resulted from filter placement, and no women had VTE complications following major abdominal surgery. In more than 40% of cases, surgery was carried out within 6 weeks of diagnosing VTE. All women received perioperative anticoagulant therapy in the form of subcutaneous low-molecular-weight heparin. No filter-related problems were encountered. Three retrievable filters were uneventfully removed 8-10 days after surgery, 2 of them on the first try. Preoperative placement of an IVCF makes major abdominal surgery feasible in women having gynecological cancer as well as life-threatening VTE. The procedure is both effective and safe. In the present cases, anticoagulation was stopped at the time of filter placement and resumed after surgery.