Inferior Vena Cava Filter Placement Research Articles

Deep Vein Thrombosis of the Left Leg: A Case of May-Thurner Syndrome.

A 56-year-old woman presented with gradually worsening shortness of breath associated with dull left leg pain over 5 days. She denied any recent travel, recent surgeries or immobilization.CT pulmonary angiography and CT venography revealed multiple bilateral pulmonary emboli and extensive left pelvic and left lower extremity deep vein thromboses. Contrast-enhanced CT showed that the right common iliac artery crossed the left common iliac vein and compressed it externally, indicative of May–Thurner syndrome. Catheter-directed thrombolysis of the left lower extremity was performed and heparin infusion was started. The patient also underwent left iliac vein balloon angioplasty with stenting and infra-renal inferior vena cava filter placement via the jugular approach to prevent further embolization.LEARNING POINTSMay–Thurner syndrome (MTS) should be suspected in patients in their second to fourth decade of life presenting with unprovoked deep venous thrombosis of the left leg.An iliac venogram is the diagnostic test of choice for MTS.MTS is treated only when it is symptomatic. The goal of treatment is to remove the clot to prevent post-thrombotic syndrome and to repair the anatomical defect.A stent was successfully deployed in the iliac vein of our patient and restoration of blood flow resulted in a dramatic improvement in the patient’s symptoms.

Malpractice litigation in the endovascular era

ObjectiveThe standard of care in the treatment of vascular disease continues to evolve as endovascular therapies develop. Currently, it is unclear how medical malpractice litigation has adapted to the “endovascular era.” This retrospective case review is the most comprehensive analysis to date of malpractice actions involving endovascular procedures performed by vascular surgeons (VSs), interventional radiologists (IRs), interventional cardiologists (ICs), and cardiothoracic surgeons (CTSs). MethodsThe legal databases LexisNexis and Westlaw were searched for all published legal cases in the United States involving endovascular procedures. The search was limited to state and federal cases up to and including the year 2016. Keywords included “malpractice,” “vascular,” “endovascular,” “catheter,” “catheterization,” “stent,” “angiogram,” “angiography,” and “surgery.” Cases involving tax revenue, insurance disputes, Social Security Disability, and hospital employment contract disputes were excluded. Data were analyzed using χ2 test. ResultsThere were 2115 initial search results identified, and 369 cases were included in final analysis. The rate of endovascular procedure-related lawsuits (per 1000 active physicians in the specialty) was highest for ICs (105.56), whereas rates for VSs and IRs were comparable (18.47 and 16.85, respectively); 93% of the IC cases were related to coronary interventions. Overall, 55% (148/271 classifiable cases) of actions were related to elective procedures. For VSs specifically, 46% (25/54) of cases arose from diagnostic angiography and inferior vena cava filter placement, two relatively minor procedure types. Overall, 83% (176/211 finalized cases) of verdicts favored defendants, with no significant differences across the specialties; 43% (157/368) of total cases involved death of the patient. Among the four specialties, there was a significant (P = .0004) difference in the primary allegation (informed consent, preprocedure negligence, intraprocedure complications, or postprocedure complications) underlying the litigation. For CTSs and VSs, there was a predominance of informed consent and preprocedure negligence allegations (70% [7/10] and 52% [28/54], respectively). Intraprocedure negligence was the most common allegation for IRs (59% [23/39]), whereas allegations were more evenly distributed among ICs. ConclusionsKey issues were identified regarding malpractice litigation involving the specialties that commonly perform endovascular procedures. Despite the increasing number of ICs doing peripheral interventions, a large majority of IC cases were related to coronary treatments. A surprisingly large percentage of VS cases were related to seemingly minor cases. There were significant interspecialty differences in the primary underlying allegations. As the scope of endovascular procedures broadens and deepens, it is important for clinicians to be aware of legal considerations relevant to their practice.

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary.

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary.

Safety of Retrievable Inferior Vena Cava Filter Placements in High-Risk Bariatric Surgery Patients

Background: Bariatric surgery patients are at a higher risk for venous thrombotic events. Inferior vena cava filter (IVCf) placement to prevent thrombotic complications is still considered controve...

Hydronephrosis caused by inferior vena cava penetration by a mobin-uddin filter

The inferior vena cava (IVC) filter placement represents an excellent protection from significant pulmonary embolism in at-risk patients. Perforation of the wall of the IVC by components of caval filters is a recognized complication. We report a case of asymptomatic hydronephrosis caused by transcaval penetration of a Mobin-Uddin filter.

Inferior Vena Cava Filter Placement and Retrieval Rates among Radiologists and Nonradiologists

PurposeTo evaluate inferior vena cava (IVC) filter placement and retrieval rates among radiologists, vascular surgeons, cardiologists, other surgeons, and all other health care providers for Medicare fee-for-service beneficiaries in the years 2012–2015. Materials and MethodsThe nationwide Medicare Physician/Supplier Procedure Summary Master Files were used to determine the volume and utilization rate of IVC filter placement, IVC filter repositioning, and IVC filter retrieval, which correspond to procedure codes 37191, 37192, and 37193, respectively. Procedural code 37193 was not available before 2012, so data were reviewed for the years 2012–2015. ResultsThe total volume of Medicare IVC filter placement decreased from 57,785 in 2012 to 44,378 in 2015, with radiologists responsible for 60% of all filter placements. Volume of IVC filter placement declined across all specialties, including radiologists, who placed 33,744 in 2012 and 27,957 in 2015. In contrast, total retrieval of IVC filters increased from 4,060 removals in 2012 to 6,166 in 2015. Retrieval rate per 100,000 Medicare beneficiaries increased from 11 in 2012 to 16 in 2015. Radiologists removed the bulk of the filters: 64% in both 2012 and 2015. Vascular surgeons, cardiologists, and other surgeons retrieved, respectively, 20%, 10%, and 5% of all IVC filters in 2012 and 22%, 9%, and 5% in 2015. ConclusionsFrom 2012 to 2015, IVC filter placement steadily decreased across all specialties. Retrieval rate of IVC filters continued to rise over the same period. Radiologists were responsible for the majority of IVC filter placements and retrievals.

Practice Patterns of Inferior Vena Cava Filter Placement and Factors That Predict Retrieval Rates: A Single-Center Institution and Review of the Literature.

BackgroundThere is a wide variability in practice patterns on the use of inferior vena cava filters (IVCFs) among institutions, which is likely due to contrasting indication guidelines published by different professional societies. The aim of the present study is to report our healthcare system use of IVCF to: 1) determine practice patterns, 2) determine factors that may predict IVCF retrieval and 3) identify areas for improvement.MethodsA retrospective review of 180 consecutive IVCF placement performed between July 2014 and December 2015 was conducted.ResultsOne hundred nine (60.6%) IVCFs were placed for absolute indications, 27 (15.0%) for relative indications, 26 (14.4%) prophylactically and 18 (10.0%) for unknown indications. Average age was 59.3 years. Ninety-five had active cancer. Surgical and medical services requested filter placement in 112 (62.2%) and 68 (37.8%) patients, respectively. Thirteen (7.2%) patients had a hematology consult prior to IVCF placement. Documentation of the presence of an IVCF was present in 118/127 (92.9%) discharge summaries, and outlined instructions for filter retrieval post-discharge were present in 20/124 (16.1%) cases. Only 33 (25.0%) IVCF were retrieved at a median interval of 162 days (range: 4 - 1,053 days). None of the factors of interest was found to be significantly associated with IVCF retrieval.ConclusionA root cause analysis identified that the lack of a structured system for IVCF tracking resulted in poor IVCF retrieval rates. This study resulted in the development of a hospital-initiated multidisciplinary team to address these issues.

Preoperative inferior vena cava filter implantation to prevent pulmonary fat embolism in a patient showing renal angiomyolipoma extension into the renal vein: A case report and literature review.

Renal angiomyolipoma without local invasion is usually considered benign entity, however, it may extend into the renal vein or the inferior vena cava. Renal angiomyolipoma with venous extension should be treated; however, surgical complications such as iatrogenic pulmonary fat embolism remain a serious concern. We present a case of a 66-year-old Japanese woman without tuberous sclerosis in whom a right-sided renal tumor was incidentally detected on ultrasonography during a health check-up. Further evaluation showed that the tumor extended into the renal vein, and she was successfully treated using preoperative inferior vena cava filter placement and radical nephrectomy. An inferior vena cava filter can prevent catastrophic pulmonary fat embolism during nephrectomy.

Factors Associated with Contralateral Deep Venous Thrombosis after Iliocaval Venous Stenting

The majority of iliac venous obstructions occur on the left side, and endovascular therapy has become the first line treatment for this condition. A left common iliac venous stent will protrude into the inferior vena cava (IVC) to some extent, thereby covering the contralateral common iliac vein (CIV) outflow. This may increase the risk of thrombosis of the contralateral iliac vein. The aim of this paper was to determine the rate of, and factors associated with, contralateral lower limb venous thrombosis after stenting, and to evaluate the results of salvage revascularisation. A total of 376 patients (102 from UCH, Galway, Ireland, 2008–16, and 274 from, CHU Nord, Marseille, France, 2000–15) with symptomatic acute or chronic left iliocaval venous obstruction were retrospectively evaluated. Either duplex ultrasound scanning (DUS) or computed tomographic venography (CTV) was used for pre- and post-operative imaging. Data were collected from the PACS system (IMPAX, Agfa, BE) of the Radiology Department, UCH, Galway, and from the electronic medical records of Vascular Surgery department, CHU Nord, Marseille. The median age of stented patients was 46 (range 15–86 years), 80% were female (301/376). Following left CIV stent placement, 10 patients later presented with a right (contralateral) iliac deep venous thrombosis (DVT) resulting in a cumulative incidence of contralateral DVT of 4% according to Kaplan-Meier analysis. Acute DVT (P=.001), non-compliance with the prescribed 6 months anticoagulation (P = 0.05), pre-operative contralateral internal iliac vein (IIV) thrombosis (P = 0.001), and pre-existing IVC filter placement (P = 0.003) were all statistically significantly associated with contralateral DVT. All patients with symptomatic contralateral iliac DVT underwent clot removal in the acute phase. The primary patency of these limbs was 100% at 3 years. Stent placement across the iliocaval confluence from the left CIV is associated with a low but definite rate of contralateral iliac vein thrombosis. Acute DVT, pre-operative contralateral IIV thrombosis, pre-existing IVC filters, and anticoagulation non-compliance are significant risk factors.

Outcomes and Direct Costs of Inferior Vena Cava Filter Placement and Retrieval within the IR and Surgical Settings

PurposeTo compare the outcomes and costs of inferior vena cava (IVC) filter placement and retrieval in the interventional radiology (IR) and surgical departments at a tertiary-care center. Materials and MethodsRetrospective review was performed of 142 sequential outpatient IVC filter placements and 244 retrievals performed in the IR suite and operating room (OR) from 2013 to 2016. Patient demographic data, procedural characteristics, outcomes, and direct costs were compared between cohorts. ResultsTechnical success rates of 100% were achieved for both IR and OR filter placements, and 98% of filters were successfully retrieved by IR means, compared with 83% in the OR (P < .01). Fluoroscopy time was similar for IR and OR filter insertions, but IR retrievals required half the fluoroscopy time, with an average of 9 minutes vs 18 minutes in the OR (P = .02). There was no significant difference between cohorts in the incidences of complications for filter retrievals, but more postprocedural complications were observed for OR placements (8%) vs IR placements (1%; P = .05). The most severe complication occurred during an OR filter retrieval, resulting in entanglement of the snare device and conversion to an emergent open filter removal by vascular surgery. Direct costs were approximately 20% higher for OR vs IR IVC filter placements ($2,246 vs $2,671; P = .01). ConclusionsFilter placements are equally successfully performed in IR and OR settings, but OR patients experienced significantly higher postprocedural complication rates and incurred higher costs. In contrast, higher technical success rates and shorter fluoroscopy times were observed for IR filter retrievals compared with those performed in the OR.

Deep venous thrombosis in pregnancy: incidence, pathogenesis and endovascular management.

Deep venous thrombosis (DVT) during pregnancy is associated with high mortality, morbidity, and costs. Pulmonary embolism (PE), its most feared complication, is the leading cause of maternal death in the developed world. DVT can also result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. Women are up to 5 times more likely to develop DVT when pregnant. The current standard of care for this condition is anticoagulation. This review discusses the epidemiology, pathogenesis, prophylaxis and diagnosis of DVT during pregnancy, and then focuses on endovascular treatment modalities. Inferior vena cava (IVC) filter placement and pharmacomechanical catheter directed thrombolysis (PCDT) in the pregnant patient are discussed, as well as patient selection criteria, and complications.

Association of Admission Glucose Level and Improvement in Pulmonary Artery Pressure in Patients with Submassive-type Acute Pulmonary Embolism.

Objective The admission glucose level is a predictor of mortality even in patients with acute pulmonary embolism (APE). However, whether or not the admission glucose level is associated with the severity of APE itself or the underlying disease of APE is unclear. Methods This study was a retrospective observational study. A pulmonary artery (PA) catheter was used to accurately evaluate the severity of APE. The percentage changes in the mean PA pressure (PAPm) upon placement and removal of the inferior vena cava filter (IVCF) were evaluated. We hypothesized that the admission glucose level was associated with the improvement in the PA pressure in patients with APE. Patients A total of consecutive 22 patients with submassive APE who underwent temporary or retrievable IVCF insertion on admission and repetitive PA catheter measurements upon placement and removal of IVCFs were enrolled. Results There was a significant positive correlation between the admission glucose levels and the percentage changes in the PAPm (r=0.543, p=0.009). A univariate linear regression analysis showed that the admission glucose level was the predictor of the percentage change in PAPm (β coefficient=0.169 per 1 mg/dL; 95% confidence interval, 0.047-0.291; p=0.009). A multivariate linear regression analysis with the forced inclusion model showed that the admission glucose level was the predictor of the percentage change in PAPm independent of diabetes mellitus, PAPm on admission, troponin positivity, and brain natriuretic peptide level (all p＜0.05). Conclusion The admission glucose level was associated with the improvement in the PAPm in patients with submassive-type APE.

Prophylactic Inferior Vena Cava Filter Utilization and Risk Factors for Nonretrieval.

Inferior vena cava filters (IVCFs) are often placed for prophylactic indications. We sought to better define the range of practice indications for placement of prophylactic IVCFs, as well as the specific retrieval rate and risk factors for nonretrieval. A retrospective, single-institution review of patients undergoing IVCF placement over a 2-year period was performed. Patients undergoing prophylactic IVCF placement were selected from a prospectively collected database. Risk factors for nonretrieval were identified using a multivariate logistic regression model. Of 615 IVCFs placed, 256 were retrievable filters placed for prophylactic indications and comprised the study cohort. The most common indications were a history of venous thromboembolic disease (43.7%), malignancy (35.1%), bleeding risk precluding anticoagulation (33.9%), and trauma (22.6%). One hundred sixty-three (63.6%) were placed preoperatively. Placement was performed in 70.3% by interventional radiology, 21.4% by vascular surgery, and 8.2% by cardiology. The most common requesting services were orthopedics (67%), general surgery (11%), neurosurgery (9%), and bariatric surgery (7%). Of all, 67.6% were placed in the inpatient setting and 32.4% in outpatients. Seventy-one (27.7%) of the 256 prophylactic filters were retrieved, with a mean indwelling time of 92 ± 74 days. Inpatients were significantly less likely to have their IVCF removed (32.4% vs 57.8%; P < .001), as were preoperative patients. This study helps define current practice trends for the placement of prophylactic IVCFs. Importantly, the specific retrieval rate for prophylactic filters is low. This suggests that prophylactic IVCF usage is suboptimal and efforts should be taken to increase retrieval, especially among inpatients and perioperative patients.

Invited commentary

Dr Harris and colleagues argue that services for vascular acute care surgery (VACS) should be established in tertiary referral centers for nonelective care. Further, they speculate that additional training and advanced certification of vascular surgeons and VACS program accreditation may be required in the future. Their analyses likely overestimate the burden of emergency vascular care. The Health Services Cost Review Commission inpatient data set they reviewed provided minimal information about the nature of patients' vascular conditions and procedures. As expected, urgent or emergency hospitalization was associated with greater resource utilization and poorer outcomes. The analysis, however, could not determine whether vascular disease or injury was the reason for admission or whether vascular procedures were needed during hospitalization to address complications or comorbidities. Vascular diagnoses were not specified, nor was the urgency of procedures performed. Many nonelective hospital admissions for vascular diagnoses are not true emergencies. Emergency Department cases may become “acute” because of lack of insurance, inadequate primary care, or because of a primary care provider's choice to first send the patient to the Emergency Department for management. All board-certified vascular surgeons, regardless of their training pathway, should be competent to handle most nonelective problems, including thromboembolectomy, vascular access procedures, angiography, inferior vena cava filter placements, amputations, treatment of pseudoaneurysms, and the like. These procedures should not require transfer to an acute vascular care center. Complex care is already regionalized to larger centers. There are 5564 United States hospitals,1American Hospital Association AHA Hospital Statistics. Fast facts on US hospitals.http://www.aha.org/research/rc/stat-studies/fast-facts.shtmlGoogle Scholar but only 3767 vascular surgeons.2American Board of Surgery Statistics and pass rates.http://www.absurgery.org/default.jsp?statsummaryGoogle Scholar The need for triage and transfer should be considered the norm. Although there can be problems with access to care and timeliness of transfer, it is unlikely that establishing VACS teams at regional centers will be the answer. Interestingly, our group at a medium-sized academic medical center (a level 1 trauma center) instituted an acute vascular surgery care service. We found the change unhelpful. After a 1-year trial, we reverted to our traditional coverage model. We still handle ruptured aneurysms, acute limb ischemia, and other complex vascular problems, but without a service dedicated to acute problems. Implementation a VACS service may make sense where most of the work is urgent or an emergency. That does not mean it is right for most programs. Management of clinical services needs to be based on referral patterns, local resources, and institutional priorities, not national directives. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Defining the burden, scope, and future of vascular acute care surgeryJournal of Vascular SurgeryVol. 66Issue 5PreviewThe paradigm of acute care surgery has revolutionized nonelective general surgery. Similarly, nonelective vascular surgery may benefit from specific management and resource capabilities. To establish the burden and scope of vascular acute care surgery, we analyzed the characteristics and outcomes of patients hospitalized for vascular surgical procedures in Maryland. Full-Text PDF Open Archive

Outcomes after inferior vena cava filter placement in cancer patients diagnosed with pulmonary embolism: risk for recurrent venous thromboembolism.

Venous thromboembolism (VTE) is a common complication in cancer patients and anticoagulation (AC) remains the standard of care for treatment. Inferior vena cava (IVC) filters may also used to reduce the risk of pulmonary embolism, either alone or in addition to AC. Although widely used, data are limited on the safety and efficacy of IVC filters in cancer patients. We performed a retrospective review of outcomes after IVC filter insertion in a database of 1270 consecutive patients with cancer-associated pulmonary embolism (PE) at our institution between 2008 and 2009. Outcomes measured included rate of all recurrent VTE, recurrent PE, and overall survival within 12months. 317 (25%) of the 1270 patients with PE had IVC filters placed within 30days of the index PE event or prior to the index PE in the setting of prior DVT. Patients with IVC filters had markedly lower overall survival (7.3months) than the non-IVC filter patients (13.2months). Filter patients also had a lower rate of AC use at time of initial PE. There was a trend towards higher recurrent VTE in patients with IVC filters (11.9%) compared to non-filter patients (7.7%), but this was not significant (p = 0.086). The risk of recurrent PE was similar between the IVC filter cohort (3.5%) and non-filter group (3.5%, p = 0.99). Cancer patients receiving IVC filters had a similar risk of recurrent PE, but a trend towards more overall recurrent VTE. The filter patients had poorer overall survival, which may reflect a poorer cancer prognosis, and had greater contraindication to AC; therefore these patients likely had a higher inherent risk for recurrent VTE. A prospective study would be helpful for further clarification on the partial reduction in the recurrent PE risk by IVC filter placement in cancer patients.

Migration of Fragment of Inferior Vena Cava Filter to Pulmonary Artery

SESSION TITLE: Imaging SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Inferior Vena Cava (IVC) filters are recommended for prevention of pulmonary embolism in patients who have deep vein thrombosis (DVT) with contraindication to anticoagulation. IVC filters are either retrievable or non-retrievable. Retrievable filters are commonly used and they should be removed within 30 days of placement. Migration of fragments of IVC filter is a rare complication of this procedure (incidence <1%). In literature, fragments have been noted to migrate mainly to the right side of the heart or the pulmonary arteries. CASE PRESENTATION: A 72 y/o male with history of COPD came to emergency room for shortness of breath. Patient had an IVC filter placed two and a half years earlier after an episode of lower extremity DVT. He was a past smoker who quit many years back.Chest radiograph on admission showed findings suspicious for foreign body in a branch of right pulmonary artery. Computerized tomography of chest was done which revealed a thin linear metallic density in one of the sub-segmental branches of right lower lobe pulmonary artery, possibly a fractured piece of IVC filter. On retrospective review of chest radiographs, this metallic foreign body was visible after six months from the placement of the IVC filter. Patient did not recall having any other procedures or catheter placement except the IVC filter placement. Cardiothoracic surgery decision was not to intervene in this patient as this was an incidental finding without squeal. DISCUSSION: Management of an IVC filter fragment that migrates into pulmonary artery can be challenging. A variety of treatment options ranging from conservative management to endovascular or open surgical extraction of the migrated struts have been suggested. There are no clear guidelines nor sufficient literature on how to best manage and treat such complex situations. General consensus is to intervene in patients with complications like perforation of pulmonary artery. This case illustrates the importance of removal of IVC filters following the guideline and as soon as it is no longer needed. CONCLUSIONS: This case illustrates the need for clinicians to be aware to remove IVC filters when its no longer needed otherwise it could lead to disastrous complications. Reference #1: Tamer Hudali, Ali Zayed et al. A fractured inferior vena cava filter strut migrating to the left pulmonary artery. Respir Med Case Rep. 2015;16:3-6 Reference #2: Nicholas A. Rogers et al. Fracture and Embolization of an Inferior Vena Cava Filter Strut Leading to Cardiac Tamponade. Circulation. 2009;119:2535-2536. DISCLOSURE: The following authors have nothing to disclose: Praneet Iyer, Rabin Shrestha, Marwan Odeesh, Anurag Mehrotra, Muhammad Zaman No Product/Research Disclosure Information

Improving Inferior Vena Cava Filter Retrieval Rate With the Implementation of a Registry and Nurse Navigator at a Large Academic Hospital After 4-Year Retrospective Inferior Vena Cava Filter Retrieval Chart Review

SESSION TITLE: Venous Thromboembolism SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Utilization of inferior vena cava filters (IVCF) for venous thromboembolisms (VTE) have exponentially increased after the advent of retrievable IVCF (RIVCF) and the expansion of accepted indications of use. A RIVCF should be removed once the risk for VTE resolves or when anticoagulation therapy can be resumed. Unretrieved IVCFs may result in filter migration, fracture, embolization, caval thrombosis, and IVC perforation. However, several single-center studies demonstrated retrieval rates (RR) of only between 14 and 45%. Thus, we first set out to ascertain our retrieval rate and then implement a system to improve it. METHODS: A four-year (January 1st 2012 to July 29th 2016) retrospective chart review of the medical records of patients who underwent IVCF placement and retrieval procedures at an interventional radiology section of a large academic hospital was conducted and IVCF retrieval rate was ascertained. An IVCF registry was created while conducting the chart review. After the conclusion of the retrospective chart review, a nurse navigator was put in charge to continue to update the registry and tract for potential IVC filter retrieval. RESULTS: A total of 387 IVCFs were placed during the four-year span of the review. The mean patient age was 60.8 years and the mean filter dwell time was 812 days. The number of IVCFs removed was 24. The number of potential retrieval opportunity was 166 (42.9%). Complication rate of retrieval was 0.775%. Adjusted for patient death, loss to follow-up, and permanent indications, the adjusted IVCF RR was 12.6%. Since January of 2017, 12 patients with the registry and coordination of a nurse navigator were identified for IVCF retrieval and had them successfully removed. CONCLUSIONS: The adjusted IVCF RR of 12.6% was lower than the range of RRs (14-45%) from several other single-center retrospective studies. Most of the studies found rates closer to 20%. Such variations may be attributed to differences in hospital operations, patient populations, or the specialty performing the procedure. However, the chart review established a baseline RR and allows us to compare it to future RRs and quantity retrieval improvements with implementation of IVCF registry and a nurse navigator. Since the implementation of those two factors, 12 IVCF were removed compared to 24 IVCF that were removed in the last 4 years without the two factors. Thus, a total of 12 patients, who otherwise most likely would have unnecessarily kept their IVCFs, benefitted from its retrieval and have their potential complications removed. CLINICAL IMPLICATIONS: Patient follow-up care is one of the most neglected part of healthcare improvement efforts which may stem from the fact that the medical reimbursement in most cases are not linked to patient’s health outcome after leaving the hospital. Nevertheless, striving to continue to make improvements in post-treatment patient care is vital for any medical field. As the median age of our patient population and the use of RIVCF continues to increase and retrieval of RIVCF remain low, we are wary of possible large influx of indwelling IVCF complications. To minimize this risk and prevent adverse health outcomes of our patients, we find value in making this improvement. DISCLOSURE: The following authors have nothing to disclose: Daniel Lee, Hanzhou Li, Hoang-Anh Vo, Ana Rita No Product/Research Disclosure Information

Concomitant venous thromboembolism at the time of primary EOC diagnosis: Perioperative outcomes and survival analyses.

To compare outcomes among women with epithelial ovarian cancer (EOC) undergoing primary surgery who present without venous thromboembolism (VTE) versus with VTE and placement of inferior vena cava (IVC) filter. Women who underwent primary surgery for EOC between 1/2/2003 and 12/30/2011 were identified. Patient characteristics were retrospectively abstracted, including diagnosis of VTE within 30days prior to surgery and placement of IVC filter. Associations with overall survival (OS) were evaluated using Cox proportional hazards models. A total of 843 patients met inclusion criteria; 817 patients (Group 1) did not have VTE at the time of EOC diagnosis and 26 patients (Group 2) had a VTE and IVC placement within 30days prior to surgery. Group 2 had worse performance status, lower albumin, and more likely to have clear cell histology. Groups 1 and 2 were similar in terms of perioperative outcomes. Mortality within 90days of surgery was 6.4% in Group 1 versus 11.5% in Group 2 (p=0.24). Although median OS for group 1 was much higher than group 2, 56.6m versus 25.7m, in this cohort this difference did not reach statistical significance (adjusted HR 1.39, 95% CI 0.85-2.29, p=0.19). Patients with VTE diagnosed at the time of EOC diagnosis have poor outcomes. This may reflect more aggressive tumor biology, worse overall health of the patient following VTE, or may reflect worse survival secondary to the VTE. Patients must be carefully selected for surgery in the setting of VTE.

Evaluating the Utilization of Prophylactic Inferior Vena Cava Filters in Trauma Patients

The lack of evidence-based guidelines on the use of prophylactic inferior vena cava filters (IVCFs) in patients after trauma has led to variation of its application. We seek to understand the national trend of the use of prophylactic IVCF in trauma population. A retrospective review of the National Trauma Databank (2002-2014) was performed to identify patients who received an IVCF after trauma. Those without a preexisting venous thromboembolism or discharge diagnosis of VTE were classified as receiving prophylactic IVCF. Multivariable logistic regression analysis was used to examine associations between the use of prophylactic IVCF and risk factors for VTE. P value ≤0.05 was considered statistically significant. Among the 2,189,994 patients evaluated, 41,155 (2%) received a prophylactic IVCF. The rate of overall IVCF placement (2.9% in 2002-2006 to 1.6% in 2014, P<0.001) and prophylactic IVCF placement (2.5% in 2002-2006 to 1.2% in 2014, P<0.001) decreased over the study period. In multivariable analysis, significant risk factors associated with the use of prophylactic IVCF were male gender (OR 1.2, 95% CI 1.1-1.2), African-American race (OR 1.2, 95% CI 1.1-1.2), injury severity score≥24 (OR 4.4, 95% CI 4.2-4.5), Glasgow Coma Scale <8 (OR 1.4, 95% CI 1.4-1.5), spinal cord injury with paraplegia (OR 5.1, 95% CI 4.7-5.6), pelvic fracture (OR 2.9, 95% CI 2.7-3.0), long bone fracture (OR 1.3, 95% CI 1.3-1.4), and solid organ injury (OR 1.2, 95% CI 1.2-1.3) (P<0.001). Patients who were treated at a level-II trauma center (OR 1.1, 95% CI 1.1-1.2, P<0.001), at a facility with ≥200 beds (OR 1.3, 95% CI 1.2-1.4, P<0.001), and those with medical insurance coverage (OR 1.4, 95% CI 1.6-1.8, P<0.001) were also more likely to receive a prophylactic IVCF. The utilization of prophylactic IVCF in trauma patients has decreased over time between 2008 and 2014. Considerable variation exists in its use, which is not fully accounted for by the VTE rate. Further study is required to evaluate appropriate indications for placement of prophylactic IVCF in trauma patients.

Factors Associated with Contralateral Deep Venous Thrombosis after Iliocaval Venous Stenting

The majority of iliac venous obstructions occur on the left side, and endovascular therapy has become the first line treatment for this condition. A left common iliac venous stent will protrude into the inferior vena cava (IVC) to some extent, thereby covering the contralateral common iliac vein (CIV) outflow. This may increase the risk of thrombosis of the contralateral iliac vein. The aim of this paper was to determine the rate of, and factors associated with, contralateral lower limb venous thrombosis after stenting, and to evaluate the results of salvage revascularisation. A total of 376 patients (102 from UCH, Galway, Ireland, 2008-16, and 274 from, CHU Nord, Marseille, France, 2000-15) with symptomatic acute or chronic left iliocaval venous obstruction were retrospectively evaluated. Either duplex ultrasound scanning (DUS) or computed tomographic venography (CTV) was used for pre- and post-operative imaging. Data were collected from the PACS system (IMPAX, Agfa, BE) of the Radiology Department, UCH, Galway, and from the electronic medical records of Vascular Surgery department, CHU Nord, Marseille. The median age of stented patients was 46 (range 15-86 years), 80% were female (301/376). Following left CIV stent placement, 10 patients later presented with a right (contralateral) iliac deep venous thrombosis (DVT) resulting in a cumulative incidence of contralateral DVT of 4% according to Kaplan-Meier analysis. Acute DVT (p=.001), non-compliance with the prescribed 6 months anticoagulation (p=0.05), pre-operative contralateral internal iliac vein (IIV) thrombosis (p=0.001), and pre-existing IVC filter placement (p=0.003) were all statistically significantly associated with contralateral DVT. All patients with symptomatic contralateral iliac DVT underwent clot removal in the acute phase. The primary patency of these limbs was 100% at 3 years. Stent placement across the iliocaval confluence from the left CIV is associated with a low but definite rate of contralateral iliac vein thrombosis. Acute DVT, pre-operative contralateral IIV thrombosis, pre-existing IVC filters, and anticoagulation non-compliance are significant risk factors.