Prophylactic Inferior Vena Cava Filter Research Articles

A Pilot Study on the Randomization of Inferior Vena Cava Filter Placement for Venous Thromboembolism Prophylaxis in High-Risk Trauma Patients

Placement of prophylactic inferior vena cava filters (pIVCFs) for the prevention of pulmonary embolism (PE) in high-risk trauma patients (HRTPs) are widely practiced despite the lack of Level I data supporting this use. We report the 2-year interim analysis of the Filters in Trauma pilot study. This is a single institution, prospective randomized controlled pilot feasibility study in a Level I trauma center. HRTPs were identified for pIVCF placement by the Eastern Association for the Surgery of Trauma guidelines. From November 2008 to November 2010, HRTPs were enrolled and randomized to either pIVCF or no pIVCF. All patients received pharmacologic prophylaxis when safe. Primary outcomes included feasibility objectives and secondary outcomes were incidence of PE, deep vein thrombosis (DVT), and death. Thirty-four of 38 enrolled patients were eligible for analysis. The baseline sociodemographic characteristics were balanced between the both groups. Results of the feasibility objectives included: time from admission to enrollment (mean, 47.4 hours ± 22.0 hours), time from enrollment to randomization (mean, 4.8 hours ± 9.1 hours), time from randomization to IVCF placement (mean, 16.9 hours ± 9.2 hours), adherence to weekly compression ultrasound within first month (IVCF group = 44.4%; non-IVCF group = 62.5%), and 1-month clinical follow-up (IVCF group = 83.3%; non-IVCF group = 100%). At 6-month follow-up, one PE in the nonfilter group and one DVT in the filter group had occurred. One non-PE-related death occurred in the filter group. Barriers to enrollment included inability to obtain informed consent due to patient refusal or no next of kin identified and delayed notification of eligibility status. Our pilot study demonstrates for the first time that a randomized controlled trial evaluating the efficacy of pIVCFs in trauma patients is feasible. This pilot data will be used to inform the design of a multicenter randomized controlled trial to determine the incidence of PE and DVT in HRTPs receiving pIVCFs versus no pIVCF.

Inferior Vena Cava Filters in Children

Although use of inferior vena cava (IVC) filters for prophylaxis against pulmonary embolism (PE) is well reported in adults, long-term studies in children are lacking. We performed retrospective review of imaging and clinical database of IVC filters for the last 12 years. Thirty-five patients (mean age: 15.5 y) underwent filter placement and/or retrieval. Indications for placement were contraindication to anticoagulation with known deep venous thrombosis (DVT) (18) or high risk of venous thromboembolism (5), recurrent DVT despite anticoagulation (1), and prophylaxis before endovascular thrombolysis (8). All filter placements were technically successful without any complications. Filter retrieval was successful in 15 of 19 attempted (79%) at a mean of 42 days. Two complications occurred during retrieval: IVC stenosis successfully treated with angioplasty and contained IVC perforation. Endothelialization of filter prevented retrieval in 4 patients. Mean follow-up was 29.3 months. No patients had IVC thrombosis, breakthrough pulmonary embolism, filter fracture, or embolism. Two patients had recurrent DVT. Our results indicate that IVC filters can be successfully placed and retrieved in children with minimal procedural complications; follow-up demonstrates acceptable complication rate owing to presence of filters. Prophylactic IVC filter placement may be considered before endovascular thrombolysis for lower extremity DVT. Retrievable filters should be used in children for appropriate indications.

Unwarranted National Variation in the Use of Prophylactic Inferior Vena Cava Filters After Trauma: An Analysis of the National Trauma Databank

The proportion of patients undergoing placement of prophylactic inferior vena cava (IVC) filters after trauma has increased dramatically in the past decade. Guidelines for prophylactic IVC filters vary from never recommended (American College of Chest Physicians/CHEST) to the more liberal Eastern Association for the Surgery of Trauma guidelines that recommend prophylactic IVC filters for patients who have both contraindications to anticoagulation and high-risk injury patterns. We hypothesized that U.S. trauma centers would practice according to Eastern Association for the Surgery of Trauma guidelines and that any variation in practice patterns would be due to variations in the number of high-risk patients treated. The National Trauma Databank (2002-2007) was used to determine center rates of prophylactic IVC filter placement per high-risk patient. Centers were excluded if they did not submit procedure and comorbidity or diagnoses codes. Patients were excluded if they had diagnoses of deep vein thrombosis or pulmonary embolism, were younger than 16 years, or died within 24 hours of presentation. A total of 1,630,385 patients and 22,808 prophylactic IVC filters from 680 centers were eligible for analysis. We identified center rates of 0 to 13 prophylactic IVC filters per 100 patient admissions and 0 to 206 filters per high-risk patient. Center characteristics could not completely explain this variation, although filters were most commonly placed in the Northeast and least frequently placed in the West (p<0.001). U.S. trauma centers demonstrate considerable variation in the use of prophylactic IVC filter placement after trauma, which could not be entirely explained by either patient or center characteristics.

Abstract No. 349: IVC size in the bariatric population: Implications for prophylactic IVC filter placement

Use of prophylactic IVC filter in high risk surgical patients has been increasing with the advent of retrievable filters. There are reports of filter migration and tilting of IVC filter in bariatric patients, and whether this was due to large IVC size, intraoperative manipulation or intrinsic property of the filter. The purpose of this study is to evaluate IVC size in bariatric patients who need IVC filter due to high risk of thromboembolic disease to see if indeed IVC size in this population might result in increase risk for filter complications.

Improving the Tracking and Removal of Retrievable Inferior Vena Cava Filters

Therapeutic and prophylactic inferior vena cava (IVC) filters should be placed based on currently accepted indications to prevent a fatal pulmonary embolism (PE). The protective effect of filters is offset by the potential for lower extremity deep venous thrombosis (DVT), caval thrombosis, and possible otherwise unnecessary life-long anticoagulation (AC). The duration of treatment for most DVTs or PEs is 3 to 6 months of AC/filter. Filters should be retrieved when duration of treatment for a DVT/PE has been met, the risk of a PE is no longer high, and/or there is no longer a contraindication to AC. An effective system that leads to improving the retrieval rate of filters must include education of the patient, a tracking system to minimize patient lost to follow-up, and dedicated personnel to oversee the process. If these goals are accomplished, interventionalists can help decrease the incidence of a fatal PE during the high-risk period, and also decrease the risk of a DVT or the use of otherwise unnecessary life-long AC in subsequent years. Currently, there is much room for improvement in the frequency that IVCF patients are systematically followed and filters are retrieved. The principles discussed in this report will be helpful in this process.

Pulmonary embolism prophylaxis with inferior vena cava filters in trauma patients: a systematic review using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines

Prophylactic inferior vena cava filters (pIVCFs) for the prevention of pulmonary embolism (PE) are controversial. Current practice guidelines (EAST and ACCP) are based on the critical appraisal of observational studies. As a result, their recommendations are conflicting and may account for practice pattern variation. The purpose of this study is to critically review the available literature and ascertain the level of evidence both for and against the use of pIVCFs for PE prophylaxis in trauma patients. We searched PubMed and Web of Science for publications from 1950 until July 2010 that assessed the efficacy of PE prevention with pIVCFs in the trauma population. We followed the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines for design, implementation, and reporting. The Newcastle-Ottawa Score was used for quality and comparability assessment. Seven observational studies met inclusion criteria for this meta-analysis, representing 1,900 patients. Only one study was published in this decade. The rate of PE was statistically lower in the IVCF group compared to a matched control group without IVCFs (OR 0.21, 95% CI 0.09-0.49). There was no significant difference in DVT. Using the MOOSE criteria these results show a decreased likelihood of PE among trauma patients who receive pIVCFs. Although these results could favor the placement of pIVCFs, the lack of contemporary use of pharmacologic prophylaxis across studies does not allow us to make firm conclusions either for or against the routine use of pIVCFs. Prospective randomized trials are needed to determine the role of pIVCFs in high-risk trauma patients.

Pharmacomechanical thrombolysis for renal salvage after filter migration and renal vein thrombosis

A 64-year-old woman underwent prophylactic inferior vena cava filter placement immediately after spinal surgery for pulmonary embolus prophylaxis. One week after surgery, acute renal failure developed, and she required hemodialysis secondary to filter migration with iliocaval and renal vein thrombosis. Pharmacomechanical thrombolysis was performed, with complete recovery of renal function and no evidence of recurrence on follow-up imaging. This report highlights an important and rare complication of filter placement and the importance of prompt thrombus debulking to preserve end organ function while reducing the risks of hemorrhagic complications. Pharmacomechanical thrombolysis allows prompt clearance of venous outflow channels and is attractive in patients with end-organ compromise and high risk for bleeding.

Cost-effectiveness of guidelines for insertion of inferior vena cava filters in high-risk trauma patients

Inferior vena cava filters (IVCFs) can prevent pulmonary embolism (PE); however, indications for use vary. The Eastern Association for the Surgery of Trauma (EAST) 2002 guidelines suggest prophylactic IVCF use in high-risk patients, but the American College of Chest Physicians (ACCP) 2008 guidelines do not. This analysis compares cost-effectiveness of prophylactic vs therapeutic retrievable IVCF placement in high-risk trauma patients. Markov modeling was used to determine incremental cost-effectiveness of these guidelines in dollars per quality-adjusted life-years (QALYs) during hospitalization and long-term follow-up. Our population was 46-year-old trauma patients at high risk for venous thromboembolism (VTE) by EAST criteria to whom either the EAST (prophylactic IVCF) or ACCP (no prophylactic IVCF) guidelines were applied. The analysis assumed the societal perspective over a lifetime. For base case and sensitivity analyses, probabilities and utilities were obtained from published literature and costs calculated from Centers for Medicare & Medicaid Services fee schedules, the Healthcare Cost & Utilization Project database, and Red Book wholesale drug prices for 2007. For data unavailable from the literature, similarities to other populations were used to make assumptions. In base case analysis, prophylactic IVCFs were more costly ($37,700 vs $37,300) and less effective (by 0.139 QALYs) than therapeutic IVCFs. In sensitivity analysis, the EAST strategy of prophylactic filter placement would become the preferred strategy in individuals never having a filter, with either an annual probability of VTE of ≥ 9.6% (base case, 5.9%), or a very high annual probability of anticoagulation complications of ≥ 24.3% (base case, 2.5%). The EAST strategy would also be favored if the annual probability of venous insufficiency was <7.69% (base case, 13.9%) after filter removal or <1.90% with a retained filter (base case, 14.1%). In initial hospitalization only, EAST guidelines were more costly by $2988 and slightly more effective by .0008 QALY, resulting in an incremental cost-effectiveness ratio of $383,638/QALY. Analysis suggests prophylactic IVC filters are not cost-effective in high-risk trauma patients. The magnitude of this result is primarily dependent on probabilities of long-term sequelae (venous thromboembolism, bleeding complications). Even in the initial hospitalization, however, prophylactic IVCF costs for the additional quality-adjusted life years gained did not justify use.

Efficacy of Prophylactic Placement of Inferior Vena Cava Filter in Patients Undergoing Spinal Surgery

Retrospective case series. To evaluate the safety and efficacy of prophylactic inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in high risk patients undergoing major complex spinal surgery. PE has been reported to be the major cause of death after spinal reconstructive surgery. Mechanical prophylaxis alone is often not sufficient whereas anticoagulation therapy carries a significant risk of bleeding complications. Prophylactic IVCF placement is advocated in high-risk patients. A total of 129 high-risk patients undergoing complex spine surgery, having prophylactic IVCF were compared to a matched cohort of age, diagnosis, and risk factors of 193 patients for whom only mechanical prophylaxis was used. Patients were observed for potential complications related to the IVCF and also for clinical signs and symptoms of PE. Eight cases (4.2%) of symptomatic PE were detected in the matched cohort control group (5 cases having combined anterior + posterior surgery and 3 patients having only posterior surgery). One of them died due to massive PE (0.5%). Symptomatic PE was detected in only 2 patients (1.5%), having combined anterior + posterior surgery due to lumbar spinal stenosis in IVCF group who responded well to medical treatment (P < 0.05). No complications were associated with filter insertion. Prophylactic IVCF is effective and safe in prevention of pulmonary embolism in patients with risk factors for PE.

Late erosion of a prophylactic Celect IVC filter into the aorta, right renal artery, and duodenal wall

We present the case of a patient with retrievable inferior vena cava (IVC) filter-related pseudoaneurysms of the infrarenal aorta and right renal artery, with associated erosion into the duodenal wall. The patient was seen 10 months following multiorgan trauma and placement of a prophylactic retrievable IVC filter (R-IVCF). Management required autogenous aortic reconstruction, caval repair, and subsequent right nephrectomy. This case demonstrates that R-IVCFs may be associated with significant risks, which is concerning, as a majority of prophylactic R-IVCFs placed after multisystem trauma are not removed.

Early detection of venous thromboembolism in patients with neuroepithelial tumor: efficacy of screening with serum d-dimer measurements and Doppler ultrasonography

The efficacy of combined serum D-dimer level measurement and Doppler ultrasonography of the lower extremity was investigated for screening of venous thromboembolism (VTE) in patients with neuroepithelial tumor. Eighty-one patients with neuroepithelial tumor were prospectively studied. All patients underwent measurement of serum D-dimer levels and Doppler ultrasonography of the lower extremity. The serum D-dimer level was measured every week, and Doppler ultrasonography was performed two and two weeks after surgery, then every two weeks until discharge, or every two weeks for patients who did not undergo surgery. If the serum D-dimer level increased over 10.0 μg/ml, Doppler ultrasonography or computed tomography was performed to detect VTE. VTE occurred in 12 (14.8%) patients (seven males and five females; age 34-75, mean 59.0 years). Only one patient was symptomatic, whereas 11 patients identified by the screening were without symptoms. Five patients were treated with anticoagulant therapy, one with prophylactic inferior vena cava filter placement with anticoagulant therapy, and the other six were closely followed up without medication. No patient died of pulmonary embolism. Serial Doppler ultrasonography showed thrombus regression or organization and no thrombus extension. The maximum serum D-dimer value was significantly higher in patients with VTE than in those without VTE (mean 14.5 vs. 3.46 μg/ml, P < 0.001). The D-dimer cutoff value of 5.4 μg/ml could be used to identify VTE with 83% sensitivity and 84% specificity. The combination of sequential serum D-dimer measurement and Doppler ultrasonography of the lower extremity is an efficient and non-invasive procedure for identifying asymptomatic VTE in patients with neuroepithelial tumor.

Incidence and Risk Factors for Deep Venous Thrombosis After Moderate and Severe Brain Injury

Patients with traumatic injuries possess a high risk of developing deep venous thrombosis (DVT), thus the need for appropriate prophylaxis. Patients with head injuries pose a unique challenge due to contraindication to the use of anticoagulation. We sought to determine the incidence of DVT and identify specific risk factors for its development in patients with head injuries. All head injury admissions between January 1, 2000, and July 31, 2006, with a length of stay >or=7 days were identified. Patient data including age, sex, injuries, Glasgow Coma Scale, Injury Severity Score (ISS), and venous duplex scan results were collected. Mechanical methods were routinely used for prophylaxis; heparin was not used in this population. Weekly duplex screening was commenced at 7 days to 10 days after admission. There were 939 patients who met criteria for review, however, duplex scans were performed in only 677, which was the population studied. Overall, DVT was present in 31.6%. There were fewer DVTs in patients with isolated head injuries (25.8%) compared with patients with those with head and extracranial injuries (34.3%)--p = 0.026. Independent predictors for DVT identified included male gender (p = 0.04), age >or=55 (p < 0.001), ISS >or=15 (p = 0.014), subarachnoid hemorrhage (p = 0.006), and lower extremity injury (p = 0.001). DVT occurs in one third of moderately to severely brain injured patients. Isolated head injuries have a lower incidence. Older age, male gender, higher ISS, and the presence of a lower extremity injury are strong predictors for developing DVT. Regular screening and the use of prophylactic inferior vena cava filters in patients with risk factors should be strongly considered.

Cost-Effectiveness of Guidelines for Insertion of Inferior Vena Cava Filters in High-Risk Trauma Patients

Inferior vena cava filters (IVCF) can prevent pulmonary embolism (PE); however, indications for use vary. While the Eastern Association for the Surgery of Trauma (EAST) 2002 guidelines suggest prophylactic IVCF use in high-risk patients, the American College of Chest Physicians (ACCP) 2008 guidelines do not. This analysis compared the cost-effectiveness of prophylactic vs therapeutic retrievable IVCF placement in high-risk trauma patients. A Markov model was created to determine incremental cost-effectiveness of these guidelines in dollars per quality-adjusted life-years (QALYs) by accounting for costs and utilities of events occurring during hospitalization and long-term follow-up. Our population was 46-year-old trauma patients at high risk for venous thromboembolism (VTE) by EAST criteria to whom either the EAST (prophylactic IVCF) or ACCP (no prophylactic IVCF) guidelines were applied. The analysis assumed the societal perspective over the patient's lifetime, using a 1-day cycle length. For base case and sensitivity analyses, event probabilities and utilities were obtained from published literature, and costs calculated from the Center for Medicare and Medicaid Services (CMS) fee schedules, the Healthcare Cost and Utilization Project database, and Redbook wholesale drug prices for 2007; for data not available from the literature, assumptions were set forth based on similarities to other populations. In base case analysis, prophylactic IVCFs were not cost-effective, being both more costly ($37,700 vs $37,300) and less effective (by 0.139 QALYs) than therapeutic IVCFs. Results were sensitive to several probabilities; the cost-effectiveness of prophylactic IVCFs varied significantly with probabilities of late venous thromboembolism (VTE) and complications related to anticoagulation. Prophylactic IVCFs were less effective, but less costly when the probability of late VTE was <4.3% per year (base case, 4.6%) among those with a removed filter, or <5.1% per year (base case, 6.1%) among those with a retained filter. The probability of anticoagulation complications, primarily gastrointestinal bleeding, was assumed to be the same in individuals with removed filters and individuals who never had a filter. Prophylactic filters were less effective, but less costly when the probability of anticoagulation complications among those with a removed filter or who never had a filter was >3.9% per year (base case, 2.5%). Prophylactic filters were less effective and more costly over the range of probabilities in the literature of anticoagulation complications for individuals with a retained filter (base case, 2.1%/y). Our analysis suggests prophylactic IVC filters are not cost-effective. This result is dependent on probabilities of long-term sequelae (VTE, bleeding complications) that are poorly characterized in the literature due to the recent advent of retrievable filters and lack of long-term follow-up in patients with retained and removed filters.

Optional Inferior Vena Cava Filters in the Trauma Patient

Trauma patients are at exceedingly high risk of development of venous thromboembolism (VTE) including deep venous thrombosis and pulmonary embolism (PE). The epidemiology of VTE in trauma patients is reviewed. PE is thought to be the third major cause of death after trauma in those patients who survive longer than 24 hours after onset of injury. In fact, patients recovering from trauma have the highest rate of VTE among all subgroups of hospitalized patients. Various prophylactic and surveillance methods have been evaluated and found helpful in certain situations, but VTE complications can occur despite such measures. Therapeutic and prophylactic uses of inferior vena cava (IVC) filters in trauma patients are reviewed. Prophylactic IVC filter use is revealed to be a controversial subject with valid arguments on both sides of the issue. With the lack of prospective randomized trials of IVC filter use in trauma, it is impossible to make evidence-based recommendations. Unfortunately, two sets of guidelines are available for insertion of filters in trauma patients, with conflicting recommendations. The introduction of retrievable IVC filters seems to offer a unique solution for VTE protection in the trauma patient population, which often consists of younger members of our population. Lastly, current generations of FDA-approved retrieval filters are discussed.

Prophylactic retrievable inferior vena cava filters in spinal cord injured patients

Background:Pulmonary embolus (PE) secondary to deep vein thrombosis (DVT) continues to be a major source of morbidity and mortality in trauma populations. Patients with cervical spinal cord injury (SCI) are particularly susceptible to developing this complication. Non-invasive methods of preventing SCI, such as lower extremity compression devices and anticoagulation, do not confer complete protection against DVT. Retrievable inferior vena cava filters (IVCFs) offer the advantage of both providing protection against PE and avoidance of long-term complications such as DVT, if removed in a timely fashion. Our goals in this study were to identify complications related to IVCF insertion and also to determine if prophylactic insertion of IVCF is effective in preventing PE in spinal cord injured patients.Methods:This was a retrospective single center study that involved cervical SCI patients who were admitted to Parkview Hospital, a level II trauma center, from January 2003 to December 2009 and underwent placement of a prophylactic IVCF within 72 hours of admission. Patients were identified from a prospectively maintained trauma registry.Results:During a 6-year period, 45 spinal cord injured patients were identified, who underwent placement of a prophylactic IVCF. There were 37 men and 8 women. There were no short-term complications associated with peripheral intravenous catheter (PIVC) insertion. Seventeen of the 45 (37%) patients underwent successful removal of the filter within 6–8 weeks of insertion. Twenty patients did not return for removal during the 6–8 week period for removal and eight patients were lost to follow-up. None of the patients who underwent prophylactic IVCF placement sustained a PE.Conclusion:Our results suggest that the use of retrievable prophylactic IVCF is a safe procedure and has the added benefit of preventing the long-term lower extremity thrombotic complications associated with their use. Even though none of the patients sustained a PE, definitive conclusions regarding the efficacy of IVCF in preventing PE could not be made due to the small sample size of our study.

Trauma patients with prophylactic IVC filter and chemical prophylaxis: a descriptive study

Trauma patients at high risk of thrombosis and bleeding often have a retrievable inferior vena cava filter (IVCF) inserted prophylactically shortly after admission for the prevention of pulmonary embolism. Despite their increasing use in trauma, controversy exists regarding patient selection, benefits and safety. In addition, chemical prophylaxis should be initiated as soon as determined to be safe to do so. Limited data exist describing the use of chemical prophylaxis and the timing of it in relation to IVCF placement in this patient population. We aim to describe such use and timing in relation to IVCF placement.

Clinical outcome of perioperative nonpermanent vena cava filter placement in patients with deep venous thrombosis or blood stasis of the vein

To evaluate the recent clinical experience with nonpermanent inferior vena cava (IVC) filter placement preoperatively, especially with regard to patients who had deep venous thrombosis (DVT) due to compression by a tumor or an aneurysm. Preoperative prophylactic IVC filter placement was performed between October 2002 and March 2008 in 48 of 83 patients who underwent IVC filter placement. IVC filter placement was performed preoperatively in 35 of the 48 patients due to DVT located distally in an iliac vein or due to IVC compression by a tumor or aneurysm. This study examined the early and mid-term outcomes resulting from nonpermanent IVC filter placement. The mean implantation period was 11.1 +/- 9.3 days (range, 3-56 days). Three patients (8.6%) experienced minor complications during the IVC filter placement. A thrombus was captured in the filter in 4 patients (8.8%). One patient in whom the filter was left as a permanent filter died during the follow-up period. No patient experienced any pulmonary embolus during the follow-up period. Nonpermanent IVC filter insertion is perioperatively useful in surgical procedures that eliminate the compression of the vein by an excision of either the tumor or aneurysm compressing the vein.

Multidetector CT Appearance of Retained Fibrin Sheath

neal clots were evacuated. The patient tolerated the procedure well and the postoperative period was uneventful. The patient again refused further treatment and alternative options of a different type of filter and requested discharge against medical advice. The patient was prescribed 5 mg warfarin as anticoagulation therapy to protect against recurrent pulmonary embolism. Incidental reports of filter complications are particularly important in patients being considered for prophylactic IVC filter insertion. Retroperitoneal hemorrhage from migration of an IVC filter and fatal rupture of the IVC are extremely rare. The incidence of IVC filter migration ranges from 0.3% to 6%, with rare migration of the filter to the heart or lung (0.1%– 1.25%) (1). Fatal retroperitoneal hemorrhage resulting from IVC perforation is one of the most serious complications noted after TrapEase IVC filter placement in the setting of anticoagulation and thrombolytic therapy for treatment of pulmonary embolism (2). Other filter-related complications are filter migration, insertion site thrombosis, filter fracture, vessel wall perforation, strut erosion through the IVC wall, recurrent pulmonary embolism, IVC obstruction, and lower-extremity venous insufficiency (3). Filter occlusion may be caused by trapping of a clot from deep vein thrombosis or formation of clot as a result of the presence of the filter itself, and it is very difficult to determine the exact cause. However, its reported incidence varies widely from 0% to 28% (4). Filter migration is associated with potentially fatal consequences. The risks include migration to locations such as the heart or pulmonary artery. IVC rupture and retroperitoneal hemorrhage caused by IVC filter migration may occur, and further investigation is needed to determine predisposing causes to this complication.

Prophylactic Inferior Vena Cava (IVC) Filter Placement May Increase the Relative Risk of Deep Venous Thrombosis After Acute Spinal Cord Injury

To determine whether the prophylactic placement of an inferior vena cava (IVC) filter after acute spinal cord injury (SCI) causes an increased incidence of deep venous thrombosis (DVT). A retrospective chart review was conducted employing charts from patients admitted to the SCI service of one inpatient rehabilitation center for 2 consecutive years. One hundred fourteen subjects met inclusion criteria, namely an acute SCI, length of rehabilitation stay greater than 7 days, and level of injury between C3 and L3. Subjects were classified into two groups: those who received a prophylactic IVC filter during their acute stay and those that did not. The occurrence of DVT during initial rehabilitation was the primary outcome measure. Other demographic and medical information including the occurrence of pulmonary embolism were also collected. Of the 114 subjects, two were excluded because of DVT occurring before rehabilitation admission. Of the remainder, 54 (47%) had prophylactic IVC filters placed. Of those with filters, 11 (20.4%) experienced a DVT during their rehabilitation stay. Of the 58 without filters, only three (5.2%) experienced a DVT during rehabilitation (p = 0.021, Fisher's exact test). Confounding factors included the Injury Severity Score and possibly the cause of injury and presence of long bone fracture. Only one individual experienced pulmonary embolism during rehabilitation hospitalization, and that was in a person with a prophylactic IVC filter. The presence of prophylactic IVC filters in acute SCI patients may actually increase the risk of DVT, which has its own associated morbidities and costs.

Sacral preservation in cauda equina syndrome from inferior vena cava thrombosis

Acute cauda equina syndrome can occur due to a variety of causes. Inferior vena cava (IVC) thrombosis has been reported as the causal source of this phenomenon twice in the relevant literature, both cases of which presented in a form complete with a component of bowel and/or bladder dysfunction. The authors report an atypical case of cauda equina syndrome in a patient in a hypercoagulable state with an extensive IVC thrombosis, resulting in acute paraparesis in the absence of incontinence or perineal anesthesia. An increasing number of prophylactic and/or therapeutic IVC filters placed in the perioperative period should engender an increased clinical suspicion for IVC thrombosis in patients presenting with acute paraparesis.