Vena cava filter deployment prior to percutaneous endovenous therapy for proximal lower limb deep venous thrombosis: should we routinely practice?

Abstract

Context Anticoagulant therapy remains the prevalent treatment for venous thromboembolism. In the new era of percutaneous endovenous intervention, there is a progressive rise in the use of percutaneous endoluminal clot dissolution techniques such as using catheter-directed thrombolysis (CDT) and mechanical aspiration thrombectomy (MAT) devices due to their established short-term benefits. Prophylactic deployment of inferior vena cava (IVC) filter during percutaneous endovenous therapy for lower extremity deep venous thrombosis (DVT) is still a debatable issue. Aims Our study aims to assess retrospectively the frequency of embolization and the need for deployment of a retrievable IVC filter during endovenous treatment of proximal lower extremity DVT using percutaneous CDT and MAT techniques. Settings and design Retrospective. Patients and methods Percutaneous endoluminal clot dissolution using either CDT or MAT for proximal lower extremity DVT was performed on 64 limbs in 58 patients of 148 patients diagnosed with proximal acute/subacute DVT in the Vascular Surgery Department of the study hospitals. An IVC filter was deployed in 32 patients prior or during the procedure. Statistical analysis Statistical analysis was performed by using IBM SPSS Statistics, version 22, for Windows program package (SPSS Inc., Chicago, Illinois, USA). Results From 58 patients who were treated for proximal DVT with clot debulking procedures, the IVC filter was prophylactically deployed in 30 (51.7%) patients. Trapped thrombus in the deployed filters as revealed on venocavography was observed in 8/30 (26.7%) filters deployed prophylactically with an overall rate of thrombus embolization during percutaneous endovenous thrombus dissolution techniques was 11/58 (18.9%) patients. Conclusion CDT could be done safely and effectively without routine prophylactic IVC filter placement in treating acute DVT. Selective filter placement may be considered in patients undergoing mechanical thrombectomy or patients with more proximal thrombus pattern with multiple risk factors.