Inferior Vena Cava Filter Utilization Research Articles

Fifteen-Year Trend in Inferior Vena Cava Filter Utilization before and after U.S. Food and Drug Administration Communications: Data from the National Inpatient Sample 2005–2019

The purpose of this study was to evaluate the contemporary trends in inferior vena cava (IVC) filter utilization in the inpatient setting following the U.S. Food and Drug Administration (FDA) safety communications and compare those trends in relation to incidence of hospital admissions involving venous thromboembolism (VTE). The National Inpatient Sample was queried between 2005 and 2019. There was an increasing trend in the utilization of IVC filters between 2005 and 2010 (P < .01). Following the FDA communication in 2010, this reversed to a decreasing trend (P < .001), which persisted following the second FDA communication in 2014, although there was no significant change in the rate of decline (P = .67). Throughout the study period, the proportion of IVC filters placed in patients with VTE increased from 70.8% to 82.2%.

Incidence and risk factors for inferior vena cava filter thrombosis detected at time of filter retrieval in patients with lower extremity deep vein thrombosis: a multicenter retrospective cohort study.

Inferior vena cava filter (IVCF) thrombosis is an uncommon complication of IVCF utilization. The aims of this study were to investigate inferior vena cava (IVC) venography before filter retrieval to determine the incidence relative to filter dwell time and risk factors of IVCF thrombosis based on the clinical data and imaging findings in patients with lower extremity deep vein thrombosis (LEDVT). The clinical data from a multicenter randomized trial conducted between October 2017 and March 2019 were reviewed to determine the incidence of IVCF thrombosis in preretrieval venography and the associated risk factors. The correlation between filter dwell times (within 90 days) and incidence was assessed. Baseline demographics, LEDVT presentation, laboratory examination, thrombus characteristics, concurrent pulmonary embolism (PE), comorbidities and risk factors for LEDVT, and IVCF-relevant information were analyzed using the independent samples t-test, chi-squared test, Fisher exact test, and regression analysis to determine the univariable and multivariable associations in assessing the risk factors of IVCF thrombosis. A total of 178 eligible patients were included, of whom 58 were in the IVCF thrombosis group and 120 were in the IVCF nonthrombosis group, and the mean filter dwell time was 22.07±27.91 days (range, 4-190 days). The overall incidence of IVCF thrombosis in patients with LEDVT who received IVCFs was 32.58% (58/178). The incidence of IVCF thrombosis was 35.25% (49/139) in the first 30 days after the IVCF placement and decreased to 22.73% (5/22) between 30 to 60 days of dwell time and to 18.18% (2/11) between 60 and 90 days of dwell time, indicating a decreasing trend within the first 90 days. The risk factors for the occurrence of IVCF thrombosis were concurrent PE [odds ratio (OR) =2.59; 95% confidence interval (CI): 1.27-5.28; P=0.01], rheumatic diseases of the immune system (OR =14.42; 95% CI: 1.52-136.41; P=0.02), IVC:filter radial ratio >0.587 (OR =0.25; 95% CI: 0.10-0.65; P<0.01), and percutaneous angioplasty (PTA) (OR =2.50; 95% CI: 1.09-5.70; P=0.03). The incidence of IVCF thrombosis at the time of filter retrieval appears to decrease with dwell time within 90 days. Concurrent PE, rheumatic diseases of the immune system, and PTA were taken into account as risk factors. An IVC:filter radial ratio of 0.587 was a protective factor against developing IVCF thrombosis. These findings require further validation in a well-designed study since the present study lacked a close follow-up.

Updated Trends in Inferior Vena Cava Filter Use by Indication in the United States After Food and Drug Administration Safety Warnings: A Decade Analysis From 2010 to 2019.

Overall inferior vena cava filter (IVCF) utilization has decreased in the United States since the 2010 US Food and Drug Administration (FDA) safety communication. The FDA renewed this safety warning in 2014 with additional mandates on reporting IVCF-related adverse events. We evaluated the impact of the FDA recommendations on IVCF placements for different indications from 2010 to 2019 and further assessed utilization trends by region and hospital teaching status. Inferior vena cava filter placements between 2010 and 2019 were identified in the Nationwide Inpatient Sample database using the associated International Classification of Diseases, Ninth Revision, Clinical Modification, and Tenth Revision codes. Inferior vena cava filter placements were categorized by indication for venous thromboembolism (VTE) "treatment" in patients with VTE diagnosis and contraindication to anticoagulation and "prophylaxis" in patients without VTE. Generalized linear regression was used to analyze utilization trends. A total of 823 717 IVCFs were placed over the study period, of which 644 663 (78.3%) were for VTE treatment and 179 054 (21.7%) were for prophylaxis indications. The median age for both categories of patients was 68 years. The total number of IVCFs placed for all indications decreased from 129 616 in 2010 to 58 465 in 2019, with an aggregate decline rate of -8.4%. The decline rate was higher between 2014 and 2019 than between 2010 and 2014 (-11.6% vs -7.2%). From 2010 to 2019, IVCF placement for VTE treatment and prophylaxis trended downward at rates of -7.9% and -10.2%, respectively. Urban nonteaching hospitals saw the highest decline for both VTE treatment (-17.2%) and prophylactic indications (-18.0%). Hospitals located in the Northeast region had the highest decline rates for VTE treatment (-10.3%) and prophylactic indications (-12.5%). The higher decline rate in IVCF placements between 2014 and 2019 compared with 2010 and 2014 suggests an additional impact of the renewed 2014 FDA safety indications on national IVCF utilization. Variations in IVCF use for VTE treatment and prophylactic indications existed across hospital teaching types, locations, and regions. Inferior vena cava filters (IVCF) are associated with medical complications. The 2010 and 2014 FDA safety warnings appeared to have synergistically contributed to a significant decline in IVCF utilization rates from 2010 - 2019 in the US. IVC filter placements in patients without venous thromboembolism (VTE) declined at a higher rate than VTE. However, IVCF utilization varied across hospitals and geographical locations, likely due to the absence of universally accepted clinical guidelines on IVCF indications and use. Harmonization of IVCF placement guidelines is needed to standardize clinical practice, thereby reducing the observed regional and hospital variations and potential IVC filter overutilization.

Prophylactic IVC filter placement in patients with severe intracranial, spinal cord, and orthopedic injuries at high thromboembolic event risk: A utilization and outcomes analysis of the National Trauma Data Bank

PurposeTo determine relationships between prophylactic inferior vena cava filter (IVCF) insertion and pulmonary embolism (PE), deep venous thrombosis (DVT), and in-hospital mortality outcomes in patients with severe traumatic pelvic/lower extremity, intracranial, and spinal cord injuries. MethodsAdult patients with severe traumatic pelvic/lower extremity, intracranial, and spinal cord injuries admitted to level I-IV trauma centers were selected from the National Trauma Data Bank (NTDB). IVCFs that were inserted both ≤48 h after admission and before a lower extremity venous ultrasound were defined as prophylactic. Associations between prophylactic IVCF insertion and PE, DVT, and overall mortality outcomes during admission were estimated using logistic regression models after propensity score matching. Additionally, factors predictive of prophylactic IVCF insertion were estimated using multivariate logistic regression. ResultsOf 462,838 patients, 11,938 (2.6%) underwent prophylactic IVCF insertion. Prophylactic IVCF utilization decreased over time (6.3% in 2008 to 1.8% in 2015). Factors associated with prophylactic IVCF placement were injury pattern, trauma center level/region, Injury Severity Score, and race. Prophylactic IVCF placement was positively associated with PE (Odds Ratio (OR): 5.25, p < 0.01) and DVT (OR: 5.55, p < 0.01), but negatively associated with in-hospital mortality compared to the propensity score-matched control group (OR: 0.46, p < 0.01). ConclusionProphylactic IVCF insertion in adult patients with severe pelvic/lower extremity fractures, intracranial injuries, and spinal cord injuries was negatively associated with in-hospital mortality, but positively associated with VTE. Further research evaluating the use of prophylactic IVCF placement in trauma patients with these specific severe injury types may be warranted.

Inferior Vena Cava Filter Utilization at Kingston Health Sciences Centre: A Comparison of Practice with Guidelines

Background: Inferior vena cava (IVC) filters offer mechanical protection against pulmonary embolism in high risk patients. Guidelines have recommended their use be limited. “Don't use inferior IVC filters routinely in patients with acute venous thromboembolism” (ASH Choosing Wisely, 2013). “For patients with acute VTE who are treated with anticoagulation, the guideline recommends against the use of an inferior vena cava filter.” (CHEST Antithrombotic Therapy and Prevention of Thrombosis, 2016) IVC filters implanted for longer than 100 days confer a significantly higher risk of complications (Odds Ratio 2.3, Dinglasan et al. 2013). We sought to determine compliance with these recommendations at Kingston Health Sciences Center (KHSC), an academic tertiary referral center with 440 inpatient beds at Queen's University in Kingston, Ontario, Canada.Methods: Approval was obtained from the Queen's Health Services Research Ethics Board.Consecutive patients with IVC filter implantation at KHSC from August 1st, 2013 to August 1st, 2016 were identified through Interventional Radiology records. All charts were retrospectively reviewed in depth by one investigator followed by review and discussion. Data extracted included: patient demographics and disposition, details surrounding IVC filter insertion and removal, and IVC filter related complications. The indication for filter implantation was classified as clearly consistent or not clearly consistent with CHEST guidelines. The category ‘lesser indication’ was subsequently added for cases of a more subjective nature where definitive categorization was challenging.Results: Between August 2013 and August 2016, 95 IVC filters were implanted at KHSC. Among these, 42 (44.2%) patients were male and the median age was 67 (ages ranged from 17 to 91). The most responsible services ordering IVC filter implantation were Critical Care Medicine (37.9%), Internal Medicine (32.6%), Surgery (12.6%) and other services such as Neurology, Family Medicine and Emergency Medicine (16.9%).Complications arose in 21 patients (22.1%) including filter-associated thrombosis (11), filter migration or tilt (8), IVC penetration (5), IVC perforation (2), and one instance of suspected IVC filter seeding with methicillin sensitive Staphylococcus aureus (MSSA) leading to bacteremia. The mean dwell time of filters that were successfully removed (n=52, 54.7%) was 69.2 days, with thirteen (18.1%) remaining indwelling beyond 100 days. Of those in whom the filter was not removed (n=43), unsuccessful retrieval attempts were made in eight, 23 patients died with their filters in situ within 100 days of implantation, and in 12 patients no record of an attempt to retrieve the device was found.Indication for IVC filter insertion was clearly consistent with CHEST guidelines in 58 (61.1%) patients. Insertion alongside therapeutic anticoagulation/thrombolysis or for prophylaxis in patients without VTE occurred in 26 patients (27.4%) and was considered not consistent with current recommendations. In 8 (8.4%) patients, a ‘lesser indication’ was identified. Lesser indications included cases where there was a need to withhold anticoagulation for less than 24 hours for procedures or surgeries, such as endoscopic retrograde cholangiopancreatography (ERCPs) or ankle open reduction internal fixations (ORIFs). Three charts had insufficient information to determine compliance.Discussion: The main limitation of this study is its retrospective nature with reliance on chart documentation. In addition, it is recognized that guidelines surrounding IVC filter use do not apply to all possible clinical scenarios. Nonetheless, restricting the use of IVC filters to appropriate indications is an important endeavour. These devices are costly, can cause harm, and do not have a strong evidentiary basis. Educational initiatives are underway to optimize use of IVC filters at KHSC. Additional interventions under consideration include development of a specific requisition form listing recommended indications, and creation of an IVC filter insertion database as a prompt for timely removal. DisclosuresHay:Celgene: Research Funding; Roche: Research Funding; Abbvie: Research Funding; Kite: Research Funding; Amgen: Research Funding; Janssen: Research Funding; Novartis: Research Funding.

Inferior vena cava filters utilization in patients with venous thromboembolism: Analysis of a database of a tertiary hospital.

The aim of the study was to assess the inferior vena cava filter (IVCF) utilization in patients with venous thromboembolism (VTE) in tertiary care. We performed a retrospective analysis of database of a tertiary hospital in 2016-2017. All the records of patients admitted for VTE or diagnosed with VTE being hospitalized for other reasons were extracted. The data collected were number of patients, who received IVCF, indications to filter insertion, PE and death rate after procedure, frequency of IVCF occlusion. 2399 patients with VTE were admitted to hospital. 442 (18,4%) of them received IVCF (239 in 2016 and 203 in 2017). Retrievable models were used in most cases (98,8%). In 119 (5,0%) patients cava filters were used due to contraindications for anticoagulation, while in 184 (7,7%) patients' anticoagulation was not effective and thrombosis progression was registered. 101 (4,2%) patients received IVCF due to high PE risk (length of floating thrombus ≥7 cm, in proximal location), high pulmonary hypertension was indication to IVCF insertion in 38 (1,6%) patients with deep vein thrombosis (DVT) in combination with pulmonary embolism (PE). Overall mortality rate after IVCF insertion was 5 (0,2%). No fatal PE was registered. IVCF occlusion during hospitalization occurred in 116 (4,8%) cases. Only 29 (1,2%) of patients were admitted back for IVCF removal. Every one in five patients with proximal DVT and/or PE receives IVCF in a routine practice in tertiary hospital. The most common indications for IVCF implantation were inability for anticoagulation or anticoagulation failure. Removal rate of retrievable cava filters is low.

Catheter-Directed Therapy: Outcomes Versus Standard of Care and Evaluation of Current Practice

BackgroundSmall studies have noted benefit with the use of catheter-directed therapy (CDT) versus standard of care in treatment of pulmonary embolism, but none have focused on the variability of clinical practice with this modality. MethodsInternational Classification of Diseases (ICD) codes were used to retrospectively identify consecutive adult patients admitted to an intensive care unit (ICU) with pulmonary embolism over a 2-year period. We evaluated inpatient mortality and major bleeding and assessed treatment variation. Results: Of 284 patients included, 46 underwent CDT (9 massive pulmonary embolism, 37 submassive pulmonary embolism). Significantly more patients who underwent standard treatment had a history of congestive heart failure and diabetes. Obesity, higher troponin levels, and right heart strain were significantly more likely in the CDT group. No significant difference in inpatient mortality or major bleeding events was observed between the treatment groups. Tissue plasminogen activator use varied widely in the CDT group, and inferior vena cava filter utilization was significantly more common in the CDT group (18; 41%) compared with the standard group (40; 17%) (P < 0.01). ConclusionsIn this study, no significant difference in inpatient mortality or major bleeding was found in patients in the intensive care unit with pulmonary embolism who underwent CDT compared with standard care. It may be beneficial to standardize this procedure given the potential benefit of CDT in patients with submassive pulmonary embolism.

State-Level Variation in Inferior Vena Cava Filter Utilization Across Medicare and Commercially Insured Populations.

OBJECTIVE. Recent research on inferior vena cava (IVC) filter utilization in the United States has largely focused on national aggregate Medicare datasets, showing recent declines. Whether these national Medicare trends are generalizable across regions and payer populations is unknown. We studied recent state-level variation in IVC filter utilization across both Medicare and private insurance populations. MATERIALS AND METHODS. Using large individual beneficiary claims-level Medicare research identifiable files and a proprietary U.S. research database of the commercially insured population, we identified all billed IVC filter placement procedures performed between 2009 and 2015. We compared population-adjusted utilization rates by state and payer type. RESULTS. Between 2009 and 2015, IVC filter utilization across the United States declined by 36.3% (from 177.9 to 113.3 procedures per 100,000 beneficiaries) in the Medicare population and by 26.6% (from 32.7 to 24.0 procedures per 100,000 beneficiaries) in the privately insured population. For the Medicare population, state-level utilization rates varied 5.2-fold, from 48.4 to 251.3 procedures per 100,000 beneficiaries in Alaska and New Jersey, respectively. For the private insurance population, rates varied 5.5-fold, from 10.8 to 59.5 procedures per 100,000 beneficiaries in Oregon and Michigan, respectively. Nationally, utilization in the Medicare population was 5.0 times higher than that in the private insurance population (range by state, from 2.0 times higher in Hawaii to 11.1 times higher in Utah). Despite the national decline, utilization in Medicare and private insurance populations increased in five and seven states, respectively. State-level IVC filter utilization rates for the Medicare population correlated strongly with those for the privately insured population (r = 0.74; p < 0.001). In both the Medicare and privately insured populations, utilization rates correlated moderately with beneficiary age (r = 0.44 and r = 0.50, respectively; p < 0.001 for both). CONCLUSION. IVC filter utilization rates vary dramatically by state and payer population, and they likely depend in part on the age of the covered population. To better identify demographic and socioeconomic drivers of utilization, future research should prioritize nonaggregate multipayer claims-level approaches.

Statewide Inferior Vena Cava Filter Placement, Complications, and Retrievals: Epidemiology and Recent Trends

Background:Public awareness of inferior vena cava (IVC) filter-related controversies has been elevated by the Food and Drug Administration (FDA) safety communication in 2010.Objectives:To examine population level trends in IVC filter utilization, complications, retrieval rates, and subsequent pulmon

National Trends in Inferior Vena Cava Filter Placement and Retrieval Procedures in the Medicare Population Over Two Decades

PurposeTo assess trends in inferior vena cava (IVC) filter placement and retrieval procedures in Medicare beneficiaries over the last two decades. MethodsUsing Physician/Supplier Procedure Summary Master Files from 1994 through 2015, we calculated utilization rates for IVC filter placement and retrieval procedures in Medicare fee-for-service beneficiaries. Services were stratified by provider specialty group and site of service. ResultsIVC filter placement rates increased from 1994 to 2008 (from 65.0 to 202.1 per 100,000 beneficiaries, compound annual growth rate [CAGR] +8.4%) and then decreased to 128.9 by 2015 (CAGR −6.2%). This decrease was observed across all specialty groups and sites of service. From 1994 to 2015, placement procedure market share increased for radiologists (from 45.1% to 62.7%) and cardiologists (from 2.5% to 6.7%) but decreased for surgeons (from 46.6% to 27.9%). Overall, procedures shifted slightly from the inpatient (from 94.5% to 86.5% of all procedures) to outpatient hospital (from 4.9% to 14.9%) settings. Between 2012 and 2015, retrieval rates increased from 12.0 to 17.7 (CAGR +13.9%). Retrievals as a percentage of placement procedures were similar across specialties in 2015 (range 13.0%-13.8%). ConclusionDespite prior dramatic growth, the utilization of IVC filters in Medicare beneficiaries markedly declined over the last decade, likely relating to evolving views regarding efficacy and long-term safety. This decline was accompanied by several filter-related market shifts, including increasing placement by radiologists and cardiologists, increasing outpatient placement procedures, and increasing retrieval rates.

Statewide Inferior Vena Cava Filter Placement, Complications, and Retrievals: Epidemiology and Recent Trends.

Public awareness of inferior vena cava (IVC) filter-related controversies has been elevated by the Food and Drug Administration (FDA) safety communication in 2010. To examine population level trends in IVC filter utilization, complications, retrieval rates, and subsequent pulmonary embolism (PE) risk. A retrospective cohort study. Patients receiving IVC filters during 2005-2014 in New York State. IVC filter-specific complications, new PE occurrences and IVC filter retrievals were evaluated as time-to-event data using Kaplan-Meier analysis. Estimated cumulative risks were obtained at various timepoints during follow-up. There were 91,873 patients receiving IVC filters between 2005 and 2014 in New York State included in the study. The average patient age was 67 years and 46.6% were male. Age-adjusted rates of IVC filter placement increased from 48 cases/100,000 in 2005 to 52 cases/100,000 in 2009, and decreased afterwards to 36 cases/100,000 in 2014. The estimated risks of having an IVC filter-related complication and filter retrieval within 1 year was 1.5% [95% confidence interval (CI), 1.4%-1.6%] and 3.5% (95% CI, 3.4%-3.6%). One-year retrieval rate was higher post-2010 when compared with pre-2010 years (hazard ratio, 2.70; 95% CI, 2.50-2.91). Among the 58,176 patients who did not have PE events before or at the time of IVC filter placement, the estimated risk of developing subsequent PE at 1 year was 2.0% (95% CI, 1.9%-2.1%). Our findings suggest that FDA communications may be effective in modifying statewide clinical practices. Given the 2% observed PE rate following prophylactic IVC filter placement, large scale pragmatic studies are needed to determine contemporary safety and effectiveness of IVC filters.

Implementation of an institutional protocol to improve inferior vena cava utilization and outcomes.

To evaluate the impact of an institutional protocol on patterns of use and outcomes of inferior vena cava filters (IVCF). Following a multidisciplinary effort, an institutional protocol involving dedicated follow-up of patients receiving IVCF and a physician education program regarding IVCF utilization, was established. We prospectively collected data of patients who received IVCF during 2015-2016, following protocol implementation (POST group). For comparison, we reviewed records of patients who received IVCF during 2009-2014, before implementation of the institutional protocol (PRE group). In the PRE and POST groups, 76 and 38 IVCF per year were inserted respectively, with an overall decrease of 50%. IVCF were more likely to be placed for therapeutic rather than prophylactic indications in the POST compared to the PRE group (P = 0.003). Follow-up rates at our coagulation clinic were significantly higher in the POST than the PRE group (100 vs. 22.9%, P < 0.0001), as were rates of attempted retrieval: 60.5% (23/38) vs. 16.7% (76/455), P < 0.0001. Failed retrieval occurred at similar rates: 15.8% (12/76) vs. 18.2% (4/22), P = 0.75. There was a trend towards a lower thrombotic complication rate in the POST than the PRE group: 2.6 vs. 11.2%, P = 0.16. Implementation of an institutional protocol significantly decreased the use of IVCF and increased the retrieval rate. Such intervention could potentially lead to lower rates of IVCF-related complications in the future.

Bundling of Reimbursement for Inferior Vena Cava Filter Placement Resulted in Significantly Decreased Utilization between 2012 and 2014

On January 1, 2012, reimbursement for inferior vena cava filters (IVCFs) became bundled by the Centers for Medicare and Medicaid Services. This resulted in ICVF placement (CPT code 37191) now yielding 4.71 relative value units (RVUs), a decrease from 15.6 RVUs for placement and associated procedures (CPT codes 37620, 36010, 75825-26, 75940-26). Our hypothesis was that IVCF utilization would decrease in response to this change as other procedures had done once they had become bundled. Including data from 2010 to 2011 (before bundling) and 2012 to 2014 (after bundling), we utilized 5% inpatient, outpatient, and carrier files of Medicare limited data sets and analyzed IVCF utilization before and after bundling across specialty types, controlling for total diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) (ICD-9 codes 453.xx and 415.xx, respectively) and placement location. In 2010 and 2011, the rates/10,000 DVT/PE diagnoses were 918 and 1,052, respectively (average 985). In 2012, 2013, and 2014, rates were 987, 877, and 605, respectively (average 823). Comparing each year individually, there is a significant difference (P<0.0001) with 2012, 2013, and 2014 having lower rates of ICVF utilization. Comparing averages in the 2010-2011 and 2012-2014 groups, there is also a significant decrease in utilization after bundling (P<0.0001). Following the bundling of reimbursement for IVCF placement, procedural utilization decreased significantly. More data from subsequent years will be needed to show if this decrease utilization continues to persist.

Research progress in the application of inferior vena cava filter on acute venous thrombosis

Anticoagulant therapy using heparins or per os vitamin K antagonists has been the treatment of choice in patients with venous thromboembolic disease for decades. However, the introduction of inferior vena cava (IVC) filters recently has provided new therapeutic choices appropriate for specific groups of patients with venous thromboembolic disease. This review aims to present all current evidence on the indications and precautions for the proper IVC filters utilization. There is still a great challenge in identifying the proper populations that would benefit from an IVC filter implantation or extraction. New randomized trials are needed to produce safe and clear guidelines of proper use.

Inferior vena cava filters: current best practices.

Venous thromboembolism (VTE) is a common cause of inpatient and outpatient morbidity and mortality. While anticoagulant therapy is considered the primary means of prevention and treatment of VTE, inferior vena cava filters (IVCFs) are often used as an alternative or adjunct to anticoagulation. With the advent of retrievable filters indications have liberalized, to include placement for primary prophylaxis in high-risk patients. However, this practice is based on limited evidence supporting their efficacy in preventing clinically relevant outcomes. Since indiscriminate use of IVCFs can be associated with net patient harm and increased health care costs, knowledge of the literature surrounding IVCF utilization is critical for providers to adopt best practices. In this review, we will provide an overview of the literature as it relates to specific clinical questions that arise when considering IVCF utilization in the prevention and treatment of VTE. Practice-based recommendations will be reviewed to provide the clinician with guidance on challenging clinical scenarios.

Optimizing the Use of Inferior Vena Cava Filters in Oncology Patients: Are All Filters Created Equally?

Many studies have supported the efficacy of inferior vena cava filters (IVCF) in the setting of venous thromboembolic disease, particularly in oncologic patients who are at increased risk. The advent of retrievable IVCF designs has prompted dramatically expanded use for patients with widely accepted indications but also disproportionately so in patients with so-called extended indications. At the same time, an alarming increase in filter-related complications has been reported both in the literature and through regulatory agencies, leading to government agency-issued warnings. The synergistic effect of these two interconnected phenomena is explained through a careful review of the evolution of IVCF device design. Critical differences exist when comparing retrievable IVCF and permanent IVCF. IVCF utilization can be optimized by prospectively identifying which patients are best served by a specific IVCF device. Careful follow-up strategies are also needed to ensure that all IVCFs are removed as soon as they are no longer needed. Finally, adjunctive techniques for removing "difficult" filters help maximize the number of IVCF removed and minimize IVCF left implanted needlessly.

National trends in utilization of inferior vena cava filters in the United States, 2000-2009.

To characterize national trends over a decade in utilization of inferior vena cava (IVC) filters in the U.S. by year,indication, hospital, and patient demographics. Retrospective cross-sectional study utilizing the Nationwide Inpatient Sample Database, 2000 to 2009. IVC filter placement was identified with International Classification of Disease, Ninth Edition codes. Survey weighting, bivariate, and multivariate analysis was performed. The number of IVC filters placed in the U.S. increased by 234% over a decade, from 56,380 in 2000 to 132,049 in 2009. A total of 84.7% of patients had a pulmonary embolism or deep venous thrombosis. A total of 94.6% of IVC filters were placed in urban hospitals. The largest number ofIVC filters was placed in the South, followed by the Northeast, Midwest, and Western regions (38.7%, 25.8%, 22.4%, and 13%, respectively). Adjusting for other patient and hospital factors, independent predictors of IVC filter placement were year, hospital size, location, teaching status, patient age group 50 to 79 years, insurance status, and urgency of admission. The use of IVC filters has dramatically increased over the last decade in the U.S., with variation in utilization based on patient and hospital characteristics. The largest utilization of IVC filters was among patients aged 50 to 79 years, Medicare recipients, and the Southern region of the U.S. The majority of patients receiving IVC filters have a diagnosis of pulmonary embolism or deep venous thrombosis.

Clinical, demographic, and medicolegal factors associated with geographic variation in inferior vena cava filter utilization: An interstate analysis

Geographic variability exists in the use of IVC filters (IVCF). We hypothesized that variation in IVCF use is incompletely explained by variation in the prevalence of deep-vein thrombosis (DVT) and pulmonary embolism (PE) and may result from different practice patterns regarding prophylactic IVCF use. We characterize geographic variation in IVCF use at the state level and evaluate its association with clinical factors, patient demographics, and the medicolegal environment. Healthcare Cost and Utilization Project State Inpatient Database records were accessed to identify 230,445 IVCFs placed from 2006 to 2008 in 33 states. Similar queries were performed for DVT and PE. Additional state data were obtained from public sources. Analyses included descriptive statistics, Spearman Correlation (SC), Wilcoxon rank-sum test, and characterization of variability. Overall, IVCF use correlated with the prevalence of DVT (SC = 0.89, P < .01). States on the East coast have significantly greater rates of IVCF use per 100K (mean ± SD = 41.2 ± 16.7 vs 27.8 ± 11.1, P < .05) and greater rates of IVCF per DVT (20.2 ± 4.5% vs 15.2 ± 2.9%; P < .005), despite similar rates of DVT per 100K (198.1 ± 51.2 vs 177.7 ± 46.7, P = NS) compared with all other states. Overall, states with the greatest rate of IVCF per DVT were (in descending order): Rhode Island, New Jersey, Florida, New York, and West Virginia. Rates of detected PE per 100K in these states were not significantly different from all other states (95.6 ± 16.6 vs 90.4 ± 16.1, P = NS). In these states, a greater percentage of IVCF recipients were older than 85 (15.3% vs 11.8%; P < .01); fewer were pediatric (0.3% vs 0.7%; P < .05) or aged 45 to 64 (26.1% vs 32.4%; P < .001). There were no differences in patient sex, race, insurance type, hospital size, or teaching status. States with high rates of IVCF per DVT were noted to have significantly greater rates of paid malpractice claims per 100K (4.9 ± 2.51 vs 1.1 ± 0.8; P = .001), and annual general surgeon liability insurance premiums ($78,630 ± 34,822 vs $43,989 ± 17,794; P < .05). Variation in IVCF use is incompletely explained by clinical factors. High rates of IVCF per DVT in some states may represent increased use of prophylactic IVCF in states with litigious medicolegal environments.

Small Bowel Volvulus in a Quadriplegic: A Rare Complication of the Simon Nitinol Inferior Vena Cava Filter.

The advent and use of inferior vena cava (IVC) filters have reduced the overall incidence of pulmonary embolism in hospitalized patients, but are not without potential complications. With the exponential increase in the utilization of IVC filters over the past two decades, it is important to consider the use of retrievable filters, where indicated, in order to potentially reduce long-term IVC filter-related complications. We report a rare case of small bowel volvulus due to IVC perforation by a Simon Nitinol filter strut in a quadriplegic patient 4 years after IVC filter insertion.

European developments in eddy current methods : International journal of pressure vessels and piping, vol. 28, no. 1–5, pp. 163–170 (1987)

On January 1, 2012, reimbursement for inferior vena cava filters (IVCFs) became bundled by the Centers for Medicare and Medicaid Services. This resulted in ICVF placement (CPT code 37191) now yielding 4.71 relative value units (RVUs), a decrease from 15.6 RVUs for placement and associated procedures (CPT codes 37620, 36010, 75825–26, 75940–26). Our hypothesis was that IVCF utilization would decrease in response to this change as other procedures had done once they had become bundled.Including data from 2010 to 2011 (before bundling) and 2012 to 2014 (after bundling), we utilized 5% inpatient, outpatient, and carrier files of Medicare limited data sets and analyzed IVCF utilization before and after bundling across specialty types, controlling for total diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) (ICD-9 codes 453.xx and 415.xx, respectively) and placement location.In 2010 and 2011, the rates/10,000 DVT/PE diagnoses were 918 and 1,052, respectively (average 985). In 2012, 2013, and 2014, rates were 987, 877, and 605, respectively (average 823). Comparing each year individually, there is a significant difference (P < 0.0001) with 2012, 2013, and 2014 having lower rates of ICVF utilization. Comparing averages in the 2010–2011 and 2012–2014 groups, there is also a significant decrease in utilization after bundling (P < 0.0001).Following the bundling of reimbursement for IVCF placement, procedural utilization decreased significantly. More data from subsequent years will be needed to show if this decrease utilization continues to persist.