Use of Retrievable Filters in Alternative Common Iliac Vein Location in High-risk Surgical Patients

Abstract

Purpose To evaluate the use of retrievable filters placed in bilateral common iliac veins in high-risk surgical patients. Materials and Methods During the 4-year study period, 10 patients received bilateral common iliac vein placement of retrievable filters for pulmonary embolism (PE) prophylaxis. These patients were at risk for venous thromboembolism (VTE) but had no evidence of VTE at the time of filter placement. In nine patients undergoing bariatric surgery, placement of a filter in the inferior vena cava (IVC) was impossible because of megacava (defined as caval diameter ≥3.0 cm). In one patient who had planned dissection of an extensive retroperitoneal tumor, there was concern that IVC location of the filter would be prone to complications secondary to intraoperative manipulation. Filter placement and retrieval were evaluated. All patients were followed clinically until 4–6 weeks after filter retrieval. Results There were 20 filters placed in 10 attempts, 18 (nine patients) through the right internal jugular vein and 2 (one patient) through bilateral femoral veins. The mean (± standard deviation) dwell time of the filters was 40 days ± 10 (range 30–71 days). All filters were successfully removed. There were no procedural complications. No clinically evident PE was noted. Conclusions Use of retrievable filters in the bilateral common iliac veins was found to be feasible and effective in preventing PE in patients with contraindications to filter placement in the IVC.