Permanent Inferior Vena Cava Filters Research Articles

Retrieval of a Greenfield Inferior Vena Cava Filter Indwelling for 29 Years.

Inferior vena cava (IVC) filters are used to prevent fatal and nonfatal pulmonary embolism in patients who otherwise cannot receive anticoagulation for venous thrombosis. While generally safe and effective, complications can arise, especially after prolonged implantation. Timely retrieval is essential once the indication for insertion has resolved. However, encountering patients with long-standing embedded filters is not uncommon. This case report discusses the successful retrieval of a permanent Greenfield IVC filter after 29 years.

The development of a novel endovascular grasper for challenging inferior vena cava filter retrieval

ObjectiveAlthough inferior vena cava (IVC) filters are commonly retrieved using a snare, lateral tilt and fibrosis around struts can complicate the procedure and sometimes require the use of off-label devices. We describe the development of a novel articulating endovascular grasper designed to remove permanent and retrievable IVC filters in any configuration. MethodsFor in vitro testing, the IVC filters were anchored to the inner wall of a flexible tube in a centered or tilted configuration. A high-contrast backlit camera view simulated the two-dimensional fluoroscopy projection during retrieval. The time from the retrieval device introduction into the camera field to complete filter retrieval was measured in seconds. The control experiment involved temporary IVC filter retrieval with a snare. There were four comparative groups: (1) retrievable filter in centered configuration; (2) retrievable filter in tilted configuration; (3) permanent filter in centered configuration; and (4) permanent filter in tilted configuration. Every experiment was repeated five times, with median retrieval time compared with the control group. For in vivo testing in a porcine model, six tilted infrarenal IVC filters were retrieved with grasper via right jugular approach. Comparison analysis between animal and patient procedures was performed for the following variables: total procedure time, the retrieval time, and fluoroscopy time. ResultsThe in vitro experiments showed comparable retrieval times between the experimental groups 1, 2, and 4 and the control. However, grasper removal of a centered permanent filter (group 3) required significantly less time than in the control (29 vs 79 seconds; P = .009). In the animal model, all IVC filters were retrieved using the grasper with no adverse events. The total procedure time (21.2 vs 43.5 minutes; P = .01) and the fluoroscopy time (4.3 vs 10 minutes; P = .044) were significantly shorter in the animal model compared with the patient group. Moreover, in the patient group, 16.7% of retrievals required advanced endovascular techniques, and one IVC filter could not be retrieved (success rate = 91.7%), whereas all the IVC filters were successfully retrieved in the animal model without the use of additional tools. ConclusionsThe novel endovascular grasper is effective in retrieving different types of IVC filters in different configurations and compared favorably with the snare in the in vitro model. In vivo experiments demonstrated more effective retrieval when compared with matched patient retrievals.

Analysis of Inferior Vena Cava Filter Indications and Retrieval Rates at an Academic Medical Center in Appalachia

Introduction: Inferior vena cava (IVC) filters are placed for prevention of pulmonary embolism in patients with venous thromboembolism (VTE) and a contraindication to anticoagulation. Additional clinical indications for IVC filters, such as pre-operative prophylaxis for VTE and extensive VTE, are controversial and vary across clinical guidelines. Current guidelines recommend that IVC filters be retrieved after resolution of their clinical indication. A common problem is failure to retrieve IVC filters when indicated, resulting in prolonged or indefinite placement of these devices. Failure to remove IVC filters contributes to an increased risk of filter-associated complications such as device migration, embolization to the cardiopulmonary circulation, perforation and increased risk of deep vein thrombosis (DVT). The goal of this study is to identify IVC filter indications and retrieval statistics at our academic medical center in Appalachia. We seek to compare our performance to national averages, identify the reasons for failure of retrieval in our patient population and develop quality improvement initiatives to improve our performance. Methods: An IRB-approved, single-institution, retrospective chart review was conducted for all patients who had an IVC filter placed between January 2020 and December 2022 at West Virginia University Hospital. Patient demographics, comorbidities, placement indications, retrieval statistics and filter-associated complications were obtained from the electronic medical record (EMR). Patients who had a permanent IVC filter placed were excluded from the final analysis. Statistical analysis was performed using Mann-Whitney U and Chi squared tests where appropriate to compare the retrieval and failure of retrieval groups. Results: The study sample (n=450) had a mean age of 65.3±15.4 years and was comprised of 54.2% males and 45.8% females. West Virginia residents comprised 82.4% of the study sample. The most common reported clinical indications for placement included VTE with a contraindication to anticoagulation (62.4%), preoperative prophylaxis for VTE (15.8%), extensive VTE (15.3%), pharmacomechanical thrombectomy (15.0%) or other (3.1%). The rate of IVC filter retrieval was 25.4% (n=114). The most common reasons for failure of retrieval were loss to follow-up (31.8%), other reasons including provider or patient preference (31.5%), patient death (28.3%), clinical indication remains present (5.7%) and unsuccessful retrieval (2.7%). Patients in the failure of retrieval group (n=114) were significantly older (69 vs 61 years, p<0.001) and had a higher frequency of clinical indications for history of VTE with a contraindication to anticoagulation (231 vs 50 patients, p<0.0001) and extensive VTE (49 vs 20 patients, p<0.0001) compared to retrieval group (n=336). There was a nonsignificant trend toward greater frequency of chronic conditions in the failure of retrieval group including cancer history (101 vs 26 patients, p=0.15), heart failure (44 vs 11, p=0.41) and hypercoagulable disease (16 vs 2 patients, p=0.26). Conclusions: Our institution had a lower IVC filter retrieval rate than the estimated average of 34% reported in a systematic review by Angel et al. Patients with comorbid conditions tended to not undergo retrieval, predisposing them to a higher risk of filter-associated complications. A history of VTE with a contraindication to anticoagulation was the most common clinical indication for placement, but the other most common indications are not universally guideline recommended which identified an area of opportunity for multidisciplinary provider education. Patient loss to follow-up is the predominant reason for failure of retrieval at our institution, which is consistent with the healthcare disparity faced by our predominantly rural, Appalachian patient population of travelling long distances to our tertiary center to obtain specialty care. Quality improvement strategies to mitigate this limitation in the context of IVC filter placement through close local follow-up for timely reassessment, retrieval evaluation and removal will be developed.

Diagnosis and treatment of venous thromboembolism and clinical application of inferior vena cava filter in China

ObjectiveThis study investigated the trend of venous thromboembolism (VTE) in China during the past 10 years and assessed the clinical application of inferior vena cava filters (IVCFs). MethodsA survey designed to investigate the diagnosis and management of VTE, specifically the application of IVCFs, was distributed nationally from January 2009 to December 2019. The respondents were mainly designated medical professionals and were asked to complete 4 major and 61 minor items in the survey. ResultsA total of 53 medical centers, including 27 radiologic and 26 vascular surgery centers, from 21 provinces in China participated in the study. These centers had diagnosed and treated 171,310 patients with VTE; 83,969 were inpatients (49%). During a 10-year period, an increasing trend of VTE diagnosis and inpatient management, 3.8-fold and 4.8-fold, respectively, was observed. The characteristics of the inpatients were as follows: 15% bilateral lower extremity deep vein thrombosis (DVT), 27% right lower extremity DVT, and 58% left lower extremity DVT. Anticoagulation therapy included unfractionated heparin with vitamin K antagonists (8%), low-molecular-weight heparin (LMWH) with vitamin K antagonists (21%), LMWH with transition to rivaroxaban (34.2%), LMWH with transition to dabigatran (2.4%), rivaroxaban alone (33.4%), and dabigatran alone (1.0%). The percentage of patients continuing anticoagulation therapy at 3, 6, 12, 24, and >24 months was 36%, 35%, 18%, 6.0%, and 5%, respectively. The in-hospital mortality for the patients with VTE was 3.2%, with DVT and pulmonary embolism responsible for 5.2% and DVT alone for 2.7%. Thrombolytic therapy was initiated for 39,046 of 83,969 patients (46.5%), including catheter-directed thrombolysis for 33,189 of the 39,046 patients (85%) and evaluation of the iliac vein using ultrasound and/or venography for 63,816 patients (76%). Urokinase was the main thrombolytic drug used (98%), followed by recombinant tissue-type plasminogen activator. Complete and partial thrombolysis was achieved in 70% and 30% of the patients, respectively. Bleeding complications were observed in 3.5% of patients, and 20% of the patients with bleeding complications required intervention. Between 2009 and 2019, 40,478 IVCFs (76% retrievable) were implanted in hospitalized VTE patients. During the enrollment period, the total number of IVCFs implanted increased by 3.8-fold, with a 4.8-fold increase in retrievable IVCFs and 7.5-fold decline in permanent IVCFs. The removal rate for the retrievable IVCFs was 72%. After IVCF implantation, 94.8% of patients received anticoagulation therapy for an average of 9.1 ± 8.6 months. The overall complication rate associated with IVCF placement was 15.5% (n = 6274 of 40,478 IVCFs), including tilting (54%), vena cava thrombosis (26.1%), caval penetration (12.6%), and migration (7.3%). No IVCF placement-related mortality occurred. ConclusionsA significant increase occurred in VTE diagnosis in China during the past decade. Anticoagulation therapy was the mainstay treatment, and catheter-directed thrombolysis was widely used. Most IVCFs placed were retrievable, and the use of permanent IVCFs has largely been discarded.

Long-Term Outcomes in Patients with Not-Retrieval Inferior Vena Cava Filter Under Anticoagulation.

Since permanent inferior vena cava (IVC) filters increase deep vein thrombosis (DVT), filter retrieval should be performed as possible. Despite the guideline recommendation, IVC filters are not always retrieved in clinical practice. To date, many patients with not-retrieval IVC filters have been prescribed anticoagulant therapy, but the long-term prognosis, including venous thromboembolism (VTE) and bleeding events, remains unknown. In this study, 195 patients who underwent IVC filter implantation between 2006 and 2017 at 3 institutions in Niigata City have been investigated about their deaths, VTE recurrence, and bleeding events. After peaking 2009, the number of IVC filter implantation gradually decreased. During observational period, there were 158 patients with not-retrieval IVC filters (the overall retrieval rate of 19.0%). The not-retrieval group included significantly older and more patients with cancer compared to the retrieval group. Anticoagulation therapy was continued in 88% of the not-retrieval group. During a mean follow-up of 5.0 years, 6 symptomatic DVT events associated with inadequate control of anticoagulation and 13 bleeding events were observed. A total of 52 patients died and only the presence of cancer was prognostic risk factor. Although long-term anticoagulation therapy may be associated with bleeding events, there were few recurrent VTE under optimal anticoagulation. It is anticipated that even if the IVC filter cannot be retrieved, appropriate anticoagulation is useful for prevention of DVT recurrence despite the risk of bleeding.

Clinical practice and volume trends of inferior vena cava filter usage at a single tertiary care center during a 19-year period

BackgroundWe investigated the clinical practice and volume trends of inferior vena cava filter (IVCF) usage at a single institution for an extended period and identified the potential factors affecting the clinical decision for placement, follow-up, and retrieval. MethodsAn institutional database was queried for IVCFs placed from 2000 to 2018 using the Current Procedural Terminology codes. The medical records were reviewed to evaluate the demographics, economic status, placement indication, IVCF type, follow-up evaluation for retrieval, and retrieval success rates. Statistical analysis was performed using SPSS, and t tests for continuous and χ2 for categorical variables. ResultsA total of 3915 IVCFs were placed from 2000 to 2018. The placement of IVCFs had increased steadily from 2000 (127 IVCFs/y), peaking in 2010 at 371 IVCFs/y and representing a 292% increase in IVCF usage. Since 2010, the number of IVCFs placed has steadily declined until 2016 to 2018, with a 426% decrease from the peak. In a subgroup of IVCFs placed for prophylaxis, the total volume trends paralleled a shift in clinical indications, peaking in 2010 and accounting for 45% of all IVCFs placed and then decreasing from 2013 to 2018 to ≤10%. Overall, 989 permanent IVCFs (25.3%) and 2926 retrievable IVCFs (74.7%) were placed during the entire study period. Before dedicated efforts to implement retrieval follow-up visits, the successful retrieval rate was ∼1% from 2000 to 2006 and had increased to ∼10% to 15% from 2007 to 2015, 36.7% in 2016, 40.2% in 2017, and 40.3% in 2018 after implementation of more active retrieval follow-up protocols. The predictors for the lack of evaluation for IVCF retrieval included an extended length of stay (P = .004) and geographic distance (P < .001). ConclusionsThe use of IVCFs during the past 19 years at our institution reflected increased usage from 2000 to 2010, corresponding to an increase in prophylactic placement, followed by a decreasing total volume from 2011 to 2018, largely attributable to decreased prophylactic IVCF placement. Improved retrieval rates were seen after implementation of an active IVCF retrieval program.

Predictors of recurrence of venous thromboembolic disease after discontinuing of anticoagulation: a prospective cohort study.

We aim to evaluate factors associated with the recurrence of thromboembolic episodes among patients with a first episode of venous thromboembolic disease during anticoagulation treatment and at least one year after treatment suspension. A prospective cohort of patients with a first episode of deep vein thrombosis confirmed by Doppler ultrasound and initiated anticoagulation treatment. Participants were registered in the Institutional Registry of Thromboembolic Disease between June 2015 and March 2019. Patients with cancer, with permanent inferior vena cava filter implant, and those who refused to participate or did not provide informed consent were excluded. All patients were evaluated within treatment at 30 days and at least one year after the suspension of anticoagulation with a D-dimer study and an ultrasound. All patients were evaluated for recurrence, bleeding (major and minor), and death. A total of 304 patients were recruited during the study period. Seventy-three percent were female, and the median age was 80 years. The rate of recurrence rate during anticoagulation treatment was 5% (N = 16/303; 95% confidence interval: 3 to 8), and 5% during post-suspension follow-up (N = 11/202; 95%CI: 3 to 9). The overall bleeding rate was 13% (N = 39; 95%CI: 9 to 17), and 5% for major bleeding. Patients who recurred had higher basal D-dimer mean, higher neutrophils and monocytes, and a higher prevalence of age-adjusted D-dimer ratio greater than 0.5 before discontinuation. In addition, they more frequently had complete leg involvement by ultrasound and received a shorter treatment. Although some baseline and pre-suspension parameters had a higher recurrence incidence, statistical significance was not reached, probably due to small statistical power and a short-term follow-up.

Inferior vena cava filter - comprehensive overview of current indications, techniques, complications and retrieval rates.

Inferior vena cava (IVC) filter has been used to manage patients with pulmonary embolism and deep venous thrombosis. Its ease of use and the expansion of relative indications have led to a dramatic increase in IVC filter placement. However, IVC filters have been associated with a platitude of complications. Therefore, there exists a need to examine the current indications and identify the patient population at risk. In this paper, we comprehensively reviewed the current indications and techniques of IVC filter placement. Further, we examined the various complications associated with either permanent or retrievable IVC filters. Lastly, we examined the current data on filter retrieval.

Absolute indications and permanent inferior vena cava filters are best

Most patients who are at risk of death from pulmonary embolism or deep venous thrombosis can and are treated by anticoagulation. With the advent of new oral anticoagulant agents, the need for monitoring can be avoided and compliance improved. The study by Brothers and Todoran1 echoes a call for the rational use of inferior vena cava (IVC) filters: to insert IVC filters in only those patients with absolute contraindications for anticoagulation and, likely, to use the well-studied permanent IVC filters on the market.

Permanent inferior vena cava filters offer greater expected patient utility at lower predicted cost

ObjectiveRetrievable inferior vena cava (IVC) filters were first approved for use in the United States in 2003 to address the long-term complications of migration, thrombosis, fracture, and perforation observed with permanent IVC filter implantation. Although Food and Drug Administration approval of retrievable IVC filters includes permanent implantation, the incidence of complications from long-term implantation appears to be greater than that reported with existing permanent IVC filters. Also, only a small fraction of such retrievable IVC filters are ever retrieved. The purpose of the present study was to determine the threshold retrieval rate at which the use of retrievable IVC filters could be justified. MethodsA Markov decision tree was constructed comparing retrievable and permanent IVC filters regarding their effectiveness and cost. A review of the reported data provided outcome probabilities, and the Tufts Medical Center Cost-Effectiveness Analysis Registry was the source of the utility values for the various potential outcomes. Medicare reimbursement rates served as a proxy for costs. A sensitivity analysis was performed for various parameters, primarily to determine the retrieval rate threshold at which the use of retrievable IVC filters would outperform the use of permanent IVC filters. ResultsBase case analysis demonstrated a greater predicted effectiveness for permanent compared with retrievable IVC filter implantation (5.41 quality-adjusted life-years [QALY] vs 5.33 QALY) at a lower cost ($2070 vs $4650). Monte Carlo simulation at 10,000 iterations confirmed the expected utility (5.4 ± 3.0 QALY vs 5.3 ± 3.0 QALY; P = .0002) and cost ($1900 ± $7400 vs $4800 ± 9900; P < .0001) to be statistically superior for permanent IVC filters. A sensitivity analysis for the filter retrieval rate demonstrated that the strategy of using a retrievable IVC filter was never preferable for utility or cost. The superiority of permanent IVC filter placement for effectiveness and cost persisted, regardless of anticipated patient-predicted annual mortality. A two-way sensitivity analysis for both IVC filter removal rate and annual patient mortality confirmed the superiority of permanent IVC filter placement at all levels. ConclusionsThe predicted effectiveness of permanent IVC filters was greater and the predicted cost lower than those for retrievable IVC filters, regardless of the IVC filter retrieval rate. This interpretation of existing reported data using Markov decision analysis modeling supports the argument that unless the long-term complication rate of retrievable IVC filters can be significantly improved, their use should be abandoned in favor of currently available permanent IVC filters.

Safety and Outcomes of Permanent and Retrievable Inferior Vena Cava Filters in the Oncology Population.

Background The role for inferior vena cava (IVC) filters in the oncology population is poorly defined. Objectives Our primary endpoint was to determine the rate of filter placement in cancer patients without an absolute contraindication to anticoagulation and the rate of recurrent VTE after filter placement in both retrievable and permanent filter groups. Patients/Methods A single-institution, retrospective study of patients with active malignancies and acute VTE who received a retrievable or permanent IVC filter between 2009-2013. Demographics and outcomes were confirmed on independent chart review. Cost data were obtained using Current Procedural Terminology (CPT) codes. Results 179 patients with retrievable filters and 207 patients with permanent filters were included. Contraindication to anticoagulation was the most cited reason for filter placement; however, only 76% of patients with retrievable filters and 69% of patients with permanent filters had an absolute contraindication to anticoagulation. 20% of patients with retrievable filters and 24% of patients with permanent filters had recurrent VTE. The median time from filter placement to death was 8.9 and 3.2 months in the retrievable and permanent filter groups, respectively. The total cost of retrievable filters and permanent filters was $2,883,389 and $3,722,688, respectively. Conclusions The role for IVC filters in cancer patients remains unclear as recurrent VTE is common and time from filter placement to death is short. Filter placement is costly and has a clinically significant complication rate, especially for retrievable filters. More data from prospective, randomized trials are needed to determine the utility of IVC filters in cancer patients.

A better inferior vena cava filter retrieval rate: A retrospective study in a single-center institution.

To determine practice patterns of inferior vena cava filters (IVCFs), retrieval rates, and reasons why retrievable-IVCFs (R-IVCFs) are kept permanent. A total of 399 patients who received IVCFs at Third Hospital of Hebei Medical University from January 2017 to December 2017 were registered and retrospectively studied. Date of demographics, baseline medical history, dwell time, reasons why R-IVCFs were kept permanent, and R-IVCFs thrombus were collected. A total of 399 IVCFs were placed during the study period including 27 permanent IVCFs and 372 R-IVCFs. Among all patients who received R-IVCFs, the mean dwell time was 18.25 ± 16.60 days, follow-up rate was 96.24% (358/372), and 337 R-IVCFs were attempted to be removed. Except one, 336 R-IVCFs were retrieved successfully (336/372, 90.32%). Sixty-four R-IVCFs thrombi were found during retrieval including 53 small-size thrombi (< 1 cm × 1 cm) and 13 large-size thrombi (>1 cm × 1 cm). Fifty-three R-IVCFs with small-size thrombi were removed successfully with no additional treatments. Twelve large-size thrombi were retrieved successfully after catheter-directed thrombolysis. With good follow-up, the retrieval rate could be improved to 90.32%. The main reasons why R-IVCFs were kept permanent were to avoid losing follow-up and overcome inappropriate selections of indications or IVCF types. And R-IVCFs with thrombus could be removed safely.

Permanent Inferior Vena Cava Filters Offer Greater Expected Patient Utility at Lower Predicted Cost

Retrievable inferior vena cava (IVC) filters were first approved for use in the United States in 2003 to address long-term complications of migration, thrombosis, fracture, and perforation observed with permanent IVC filter implantation. Although approval of retrievable IVC filters includes permanent implantation, the incidence of complications appears to be greater from long-term implantation than from existing permanent IVC filters, and only a small fraction of such retrievable IVC filters are ever retrieved. The purpose of this study was to determine the threshold retrieval rate at which the use of retrievable IVC filters can be justified. A Markov decision tree was constructed comparing retrievable and permanent IVC filters. Review of the literature provided probabilities, and the Tufts Cost-Effectiveness Analysis Registry was the source of the utility values for the various potential outcomes. Medicare reimbursement rates were used as a proxy for costs. Sensitivity analysis was performed for various parameters, primarily to determine the retrieval rate threshold at which use of retrievable IVC filters outperformed permanent IVC filters. Base case analysis demonstrated a greater predicted utility for permanent over retrievable IVC filter implantation (4.68 vs 4.49) at a lower cost ($1080 vs $4160) with a greater net monetary benefit for willingness to pay of $65,000 ($303,000 vs $288,000). Monte Carlo simulation at 10,000 iterations confirmed expected utility (4.65 ± 3.03 vs 4.48 ± 3.02; P < .00001), cost ($1040 ± $4640 vs $4320 ± 8140; P = .00007), and net monetary benefit ($301,000 ± $197,000 vs $287,000 ± $196,000; P < .00001) to be statistically superior. Sensitivity analysis for filter retrieval rate demonstrated that the strategy of use of a retrievable IVC filter is never preferable for any of the three outcomes. The superiority of permanent IVC filter placement for all three outcomes persists regardless of anticipated patient predicted annual mortality. Two-way sensitivity analysis for both IVC filter removal rate and annual mortality confirmed superiority of permanent IVC filter placement at all levels. The predicted utility of permanent over retrievable IVC filters is higher and the predicted cost is lower regardless of rate of ICV filter retrieval. This implies that unless the long-term complication rate of retrievable IVC filters can be significantly improved, regardless of retrieval rate, their use should be abandoned in favor of currently available permanent IVC filters.

Characteristics of Inferior Vena Cava Filter Placement, Management, and Retrieval at a Multi-Center Institution

Background: Retrievable inferior vena cava filters (IVCF) were developed to address the adverse events associated with permanent IVCF. However, this benefit cannot be fully appreciated if filters are not removed in a timely manner and when appropriate. Although there are clinical scenarios when permanent placement is desired, studies show that these situations are far outweighed by scenarios of medically inappropriate non-retrieval. There is substantial evidence describing adverse events related to IVCF such as filter thrombosis, DVT, fracture, perforation, and migration. Furthermore, evidence supporting the benefit of IVCF to prevent the development or progression of pulmonary embolism remains controversial. Therefore, indications for IVCF placement are not standardized at most centers. Specialty societies, such as radiology and cardiology, have differing recommendations for filter placement. IVCF placement is not uncommon (of 130,643 patients hospitalized at 263 hospitals with acute venous thromboembolism [VTE], 15% had IVCF placed) and retrieval rates of non-permanent filters remain low (18-41%). Methods: This study assesses IVCF indications, removal rate, complications, and practice patterns at a multi-center institution via retrospective chart review. Procedure codes and associated diagnosis codes were used to identify 626 adult patients who had IVCF placed over a span of 5 years by either interventional radiology, vascular surgery, or interventional cardiology. Of note, patients were excluded from analysis if they had a documented death within 60 days of filter placement. Descriptive statistics, chi-squared tests, and Wilcoxon rank-sum tests were used for statistical analysis. All IVCF evaluated were retrievable filters. Results: Most IVCF were placed by interventional radiology (77%) as expected. Retrieval rate was 27%. No significant difference was found in retrieval rates among the procedural specialties. Also, retrieval rate was not significantly different between specialty groups that followed the patient after filter placement, including radiology, vascular surgery, or hematology (p value: 0.5382). Overall, 58% of IVCF were unmanaged after placement and, as expected, this was associated with a higher rate of non-retrieval (p value: 0.0001). There was no significant difference in retrieval rate among inpatient or outpatient procedures (p value: 0.2067). Patients in the retrieval group had a lower Charlson Comorbidity Index score than those in the non-retrieval group (p value: 0.0001). The most common indications for placement were acute VTE with contraindication to anticoagulation (40%) and anticoagulation failure (21%). The most common filter complication was filter thrombus (2%). Primary care providers were the most common ordering provider group that requested filter placement (51% of filter placement requests). Interestingly, patients with Medicare/Medicaid had a lower rate of retrieval than patients with any other coverage, including no coverage (20% versus 35%, p value &lt;0.0001). Recurrent VTE occurred in 44 patients (not including filter thrombus) and 9 of those events occurred after filter removal. 62% of patients received anticoagulation therapy during or after filter placement. Conclusion: Lack of follow-up and filter non-removal continues to remain a problem since the emergence and use of IVCF. Surprisingly, our study didn't show that retrieval rates were different based on inpatient or outpatient status, or by follow-up specialty. We did not expect to find that retrieval rates would be lowest in patients with Medicare/Medicaid, or that the most frequently ordering provider group would be primary care providers (over pulmonologists or hematologists, for example). Even after excluding patient deaths within 60 days of filter placement, we still found retrieval rates to be low. As a retrospective study, we can only show association and there may be unique characteristics of our centers that affect external validity. Also, in some clinical scenarios permanent filter placement may be indicated. Regardless, this analysis challenges assumptions regarding the factors involved with filter placement and persistently low rates of retrieval. It also proposes new targetable areas for collaboration and improvement. Disclosures No relevant conflicts of interest to declare.

Continuing Use of Inferior Vena Cava Filters Despite Data and Recommendations Against Their Use in Patients With Deep Venous Thrombosis

The purpose of the present investigation is to determine the response to the evidence and recommendations against the use of inferior vena cava (IVC) filters in patients with deep venous thrombosis (DVT). This was a retrospective cohort study based on administrative data from the National Hospital Discharge Survey 1979 to 2006 and from the National (Nationwide) Inpatient Sample 2007 to 2014. The number of IVC filters inserted in patients with lone DVT peaked in 2009 and then decreased from 2009 to 2014. The proportion of patients with lone DVT who received an IVC filter peaked in 2010 and then decreased from 2010 to 2014. Both the number of IVC filters inserted yearly and the proportion of patients who received an IVC filter remained higher than in 1998 when a randomized controlled trial showed no reduced mortality with permanent IVC filters in patients with DVT. In conclusion, large numbers of patients with lone DVT continue to receive IVC filters despite a randomized controlled trial that showed no reduced mortality with IVC filters in patients with DVT and despite clinical guideline recommendations against the use of IVC filters in such patients.

Kissing Sheath Technique for Permanent Inferior Vena Cava

In patients where anticoagulation therapy is contraindicated, Inferior Vena Cava (IVC) filters are used as an option to prevent Pulmonary Embolism (PE). There are many classifications of Vena Cava filters the two main groups are; those intended for permanent implantation and the other temporary (which are to be retrieved at a later date). Permanent IVC filters are not designed to be removed, unless unexpected clinical circumstances arise. We describe a complex case of retrieval of a permanent IVC filter, though well documented; it is the first of its kind to be recorded in the Caribbean.

Tilt and caval penetration among permanent and retrievable inferior vena cava filters of similar design

Tilt and caval penetration among permanent and retrievable inferior vena cava filters of similar design

Permanent inferior vena cava filter in the treatment of deep vein thrombosis of lower limb: mid-term and long-term outcome and the clinical significance

Objective To assess the mid-term and long-term efficacy of the permanent inferior vena cava filter in the treatment of deep vein thrombosis of lower limb and discuss the clinical significance of inferior vena cava filter. Methods Retrospectively analyze on the 86 cases with deep vein thrombosis of lower limb (41 males and 45 females, aged 50 to 94 years, mean age was 71.8 years) treated with implantation of permanent inferior vena cava filter in inferior vena cava from Janunary 2010 to October 2015.In these patients, there were 51 cases with embolism in the left leg, 25 cases in the right leg, 10 cases in both legs and 6 cases were accompanied with pulmonary embolism. The cases without contraindication underwent catheter directed thrombolysis and even percutaneous transluminal angioplasty or stents subsequently if necessary after inferior vena cava filter implantation. All the cases with no contraindication were treated with anticoagulant therapy. Results All the 86 patients were implanted inferior vena cava filter (B.Braun Vena Tech LP 76 and Cordis TrapEase 10)successfully. Sisty-five cases were underwent inferior vena cava filter implantation only, while 21 cases were treated with inferior vena cava filter implantation and catheter directed thrombolysis or even percutaneous transluminal angioplasty and stents. During the follow-up period(12 to 81 months, mean time was 51 months), 27 patients died dueing to malignant tumor(17 cases) and other diseases(10 cases) rather than complications caused by inferior vena cava filter. Three patients had recurrence of deep vein thrombosis and 2 patients suffered from the thrombosis induced by stenosis of stents. Inferior vena cava filter appered tilted with angle less than 15 degrees in 6 cases. Three cases suffered from new thrombosis below the filter and 2 cases complained of the filter migration. No case was found with fracture of filter, perforation of the inferior vena cava, bleeding or pulmonary embolism(new onset or recurrent). Conclusions Application of permanent inferior vena cava filter may cause complications, though it is an effective approach to prevent pulmonary embolism in patients with deep vein thrombosis of lower limb. However, permanent inferior vena cava filter may be fit for patients with old age, incurable cancer or limited expected life. Key words: Thrombosis, deep vein; Vena cava filters; Pulmonary embolism; Treatment outcome

Why Temporary Filters Are Not Removed: Clinical Predictors in 1,000 Consecutive Cases

Compared to permanent inferior vena cava (IVC) filters, higher complication rates occur with long-term use of temporary IVC filters. We aimed to identify patient clinical factors at the time of placement that could predict failure to remove a temporary IVC filter. A retrospective review was performed of both vascular surgery and interventional radiology prospective databases between December 2008 and December 2013. We analyzed a total number of 1,024 consecutive, temporary IVC filters stratified by whether retrieval was attempted or made permanent. Univariate, multivariate, and prediction modeling analyses with internal validation were performed on abstracted data, which included risk factors, treatment modalities, and indications for IVC filter placement. Of 1,024 temporary IVC filters, removal was attempted in 60% and no attempt at removal (kept permanent) in 40%. Of the 619 with attempted removal, the overall successful retrieval rate was 95%. The majority of filters were not attempted to be removed because of persistent filter indications (360 cases). Risk factors associated with IVC filter permanence included male sex, older age, history, or indication of venous thromboembolism (VTE) with inability to anticoagulate, malignancy, and neurologic condition. Risk factors most predictive of permanence in the multivariate model were malignancy (odds ratio [OR]: 3.0, P<0.001) or neurologic disorder (OR: 2.69, P=0.0005). Validation revealed our model had a sensitivity of 60.4% and specificity of 69.9%. Our study shows that patients who are more likely to have a temporary IVC filter kept permanent are more likely to be older males with a history of malignancy, neurologic condition, or VTE. These factors are also predictive of permanence and can be used in our predictive model to provide insight into the significant preoperative risk factors that should play into the decision-making process.

Role of inferior vena cava filters in transplant patients.

This study evaluates the selection, use, and risks of permanent and retrievable inferior vena cava filters (IVCFs) in patients who have undergone organ transplantation. Single-center retrospective review of 35 patients who had an IVCF placed following organ transplantation. Patient demographics, IVCF indication, and eligibility for retrieval were reviewed. Computed tomography (CT) studies showing the filter (n=22) were evaluated independently for IVCF adverse effects. Thirty-two (91%) of 35 patients had retrievable IVCFs placed while three (9%) patients received permanent IVCFs. Filter retrieval was indicated in three of the 32 patients receiving retrievable filters and was performed in two cases. Patients were ineligible for retrieval due to short life expectancy, complications/contraindications to anticoagulation, extended filter dwell time, lost to follow-up, and undetermined therapeutic value of anticoagulation. Current practices of filter placement usually dictate placing a retrievable IVCF in transplant patients. However, transplant patients are unlikely to be eligible for filter retrieval especially in situations of advanced age and comorbidities. Given the low incidence of eligibility for retrieval in this patient population, these results suggest preferential placement of permanent filters may reduce the potential morbidity due to filter-related complications, such as strut perforation, in transplant patients.