Inferior Vena Cava Filter Retrieval Rates Research Articles

Improving the rate of inferior vena cava filter retrieval through multidisciplinary engagement

BackgroundThe placement of retrievable inferior vena cava (IVC) filters occurs commonly, but retrieval rates remain low. Consequently, there is an unmet clinical need to ensure appropriate follow-up and retrieval of these devices. ObjectivesTo determine the association between an IVC filter surveillance team with filter retrievals or a documented filter plan, time to retrieval, and incidence of filter complications or recurrent venous thromboembolism. MethodsAmbidirectional cohort study evaluating consecutive IVC filter insertions before and after the implementation of a multidisciplinary surveillance team (MDST). We report an odds ratio (OR) with 95% CIs, adjusted by age, sex, weight, and malignancy status. ResultsOverall, 453 patients were included, with 272 individuals in the pre-MDST cohort and 181 individuals in the post-MDST cohort. The MDST was associated with a higher composite primary outcome of IVC filter retrieval or a documented filter plan from 79.4% in the pre-MDST cohort to 96.1% in the post-MDST cohort (OR, 6.44; 95% CI, 3.06–15.84). Compared with the pre-MDST cohort, IVC filter retrieval rates were higher in the post-MDST cohort (52.6%–73.5%, respectively; (OR, 2.50; 95% CI, 1.67–3.78). The MDST was associated with a shorter median time-to-filter retrieval (187–150 days, hazard ratio, 1.78; 95% CI, 1.39–2.29), but there was no significant difference when comparing symptomatic or clinically significant IVC filter complications, recurrent venous thromboembolism, or mortality. ConclusionOur study demonstrates the importance of a structured program to ensure timely IVC filter retrieval and ultimately improve patient care.

Thromboembolic clinical event rates and mortality for patients with and without inferior vena cava filter retrieval in a multicenter study

ObjectiveDespite the widespread use of inferior vena cava filters (IVCFs), no large controlled trials have examined the IVCF retrieval rates and clinical events for patients without retrieved IVCFs. We hypothesized that IVCF retrieval success would decrease as the time from placement increased and that the clinical event rates would be more prevalent for those without a retrieved IVCF. We evaluated retrieval success as a function of time and compared the rates of venous thromboembolism and mortality between patients who had undergone IVCF retrieval within 12 months vs patients with unsuccessful IVCF retrieval. MethodsAll patients who had undergone IVCF placement between 2011 and 2017 with available follow-up data at eight community hospitals were enrolled in our retrospective cohort study. The procedure dates, incidence of subsequent deep vein thrombosis (DVT) and pulmonary embolism, and mortality dates were collected. Patients were classified as having a nonretrieved IVCF if their IVCF had not been retrieved after ≥12 months of follow-up. ResultsOf 1709 patients who had undergone IVCF placement, IVCF retrieval was successful for 770. We found a significant (P = .018) decrease in retrieval success as the time from IVCF insertion increased. After a mean of 36 ± 16 months, the incidence of subsequent DVT was lower in the retrieved group than in the nonretrieved group (8.1% vs 11.9%; P = .05; hazard ratio, 0.65; 95% confidence interval, 0.42-1.00). Mortality was lower for those with retrieved than for those without retrieved IVCFs (8.8% vs 28.8%; P < .001; hazard ratio, 0.5; 95% confidence interval, 0.35-0.7). No significant difference was found in the rate of pulmonary embolism. ConclusionsIVCF nonretrieval was more likely for older patients with a greater prevalence of comorbid conditions. Increased rates of subsequent DVT and mortality were observed for patients without IVCF retrieval. Finally, the likelihood of successful IVCF retrieval decreased with increased time from IVCF placement.

Structured team-oriented program to follow patients after vena cava filter placement: a step forward in improving quality for filter retrieval

To reduce inferior vena cava filter (IVCF) related complications, retrieval is recommended whenever possible. Nevertheless, IVCF retrieval rates remain lower than expected, likely due to insufficient follow-up after placement. We evaluated the value of a structured program designed to follow patients by the interventional radiology team up to 5 months after IVCF placement. We prospectively enrolled 366 consecutive patients (mean age 64 ± 17 years; 201 men and 165 women) who benefited from IVCF between March 2015 and February 2020. The program consisted of advising the patient and clinicians to consider IVCF retrieval as soon as possible (standard workflow) and systematically planning an additional follow-up visit at 5-month. Clinical and technical eligibility, as well as technical success for retrieval (TSR) were evaluated. At 5-months, 38 (10.4%) patients were lost to follow-up, and 47 (12.8%) had died. Among survivors, the overall retrieval rate was 58%. The retrieval rates were 83% and 97% for the clinically eligible and technically eligible patients for retrieval, respectively. The 5-month visit enabled 89 additional retrievals (47.8%) compared to the standard workflow. No significant difference was seen in TSR before and after 5 months (p = 0.95). Improved patient tracking with a dedicated IVCF program results in an effective process to identify suitable patients for retrieval and drastically improves retrieval rates in eligible patients. Involving interventionalists in the process improved IVCF patient management.

THE ABANDONED INFERIOR VENA CAVA FILTER: IS IT A BIG DEAL? IVC FILTER RETRIEVAL RATES AND CLINICAL OUTCOMES OF NON-RETRIEVAL

Many patients with inferior vena cava filters (IVCF) never have them retrieved and there are no well validated studies examining IVCF retrieval rates and clinical events in patients with abandoned IVCF. In this retrospective cohort study, we evaluate differences in the rates of venous

Inferior Vena Cava Filter Retrieval Trends: A Single Center Experience

Background: Inferior vena cava (IVC) filters are indicated in patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) who either have contraindications to or have failed anticoagulation (AC). Given rising concerns about their safety and efficacy, the FDA has issued a communication urging clinicians to remove filters (optimally, within 90 days post-implantation). According to national data retrieval rates remain low. Our study aimed to assess IVC filter retrieval rates and factors that influence retrieval. Methods: This is a single center, retrospective cohort study of patients who had IVC filter placement between December 2015 and December 2018. Subjects were identified using procedural codes for IVC filter insertion; data regarding demographics, comorbidities, retrieval, IVC filter-related complications and subsequent thromboembolic events were obtained by direct chart review. Survival analyses and a Cox regression model were performed using JMP statistical software. Results: Over 3 years, 494 patients with IVC filters were identified; 305 (62%) were retrievable. The average age at placement was 69±16 years; 249 (50%) were men and 332 (67%) were Caucasian. After excluding patients who died or were lost to follow-up within 30 days of placement or were discharged to hospice from the index admission, 258 patients with retrievable filters remained (54 retrieved). Indications for IVC filter placement were PE ± DVT 90 (35%), proximal DVT 159 (62%) and prophylactic 9 (3%). Forty two percent of patients (109) were restarted on AC at discharge, while an additional 18% (total 155) received AC at some point thereafter. The rate of retrieval was 8% at 90 days, 23% at 1 year and 28% at 2 years (Figure A). The proportional hazards model identified resumption of AC at any time (HR 3.11, 95%CI 1.6-6.8, p=0.0006) as the strongest predictor of retrieval; AC at discharge was not predictive. Advanced age at placement (HR 0.97 per unit change, 0.96-0.99, p=0.004) and active malignancy (HR 0.5, 95%CI 0.24-0.98, p=0.04) were associated with a lower likelihood of retrieval. The initial thrombotic event, the reversibility of the contraindication to AC, the placing service, sex, ethnicity and other comorbid conditions did not have an impact on retrieval. Kaplan-Meier analysis revealed that subjects who ever resumed AC had significantly higher rates of retrieval at 90 days (11% vs 3.4%) and at 1 year (33% vs 9.7%, log-rank p=0.0003, Figure B) when compared to those who did not. Only four patients experienced IVC filter-related complications (2 filter thrombosis, 1 IVC penetration, 1 device tilting); all occurred 2 or more years after placement. Recurrent thromboembolic events occurred in 50 patients (5 PE, 48 proximal DVT) with no significant difference in frequency between subjects with retrieved and non-retrieved filters; one PE and one DVT occurred at 1 month and 1 week respectively after retrieval. Conclusion: Despite efforts to increase awareness of IVC filter-associated complications, the unweighted retrieval rate remained below the nationally reported average of 30%. Persistent risk factors for thrombosis such as active malignancy or increasing age and poor prognosis may play a role in the decision to defer retrieval. In our study, resumption of AC proved a powerful predictor of retrieval, with rates approaching expected values in this population. Active surveillance for resolution of contraindications to AC post-IVC filter placement is crucial in increasing retrieval rates. Figure Disclosures No relevant conflicts of interest to declare.

Usefulness of a Computerized Reminder System to Improve Inferior Vena Cava Filter Retrieval and Complications

Inferior vena cava filters (IVCF) are associated with complications which may be due to delayed retrieval. Initiation of an automated reminder system may improve retrieval rates and reduce complications. A computerized reminder system, which provides interactive email reminders after implantation while collecting IVCF use data, was implemented. IVCF retrieval was compared before ("reminder not provided" group) and after ("reminder provided" group) implementation. Data regarding implantation, retrieval, and complications were collected. The primary efficacy outcome was retrieval rate, and the primary safety outcome was indwelling complication rate. Secondary outcomes were time to retrieval and a composite adverse outcome defined as IVCF thrombosis, deep venous thrombosis (DVT), pulmonary embolism, and death. A total of 1,070 IVCF insertions were included, 715 in the "reminder not provided" group and 355 in the "reminder provided" group. Patient age (61 vs 64 years, p = 0.95) and gender (42% vs 40% female, p = 0.55) were similar in the "reminder not provided" and "reminder provided" groups, respectively. In the "reminder provided" group, the retrieval rate was higher (148/297 [49.8%] vs 223/715 [31.2%], p = 0.0001), the indwelling complication rate was lower (30/319 [9.4%] vs 115/715 [16.1%], p = 0.005), and the time to retrieval was shorter (112 days vs 146 days, p = 0.02). The composite adverse outcome occurred less frequently in the "reminder provided" group: (85/355 [23.9%] vs 297/715 [41.5%], p = 0.0001). The system was associated with increased odds of IVCF retrieval (odds ratio 2.56; 95% confidence interval: 1.82 to 3.59; p <0.0001) and reduced odds of the composite adverse outcome (odds ratio 0.72; 95% confidence interval: 0.60 to 0.80; p <0.0001). In conclusion, implementing a computerized email reminder system was associated with higher IVCF retrieval rates, fewer indwelling complications, and shorter dwell times.

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

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.

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

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

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

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

Establishment of an inferior vena cava filter database and interventional radiology led follow-up - retrieval rates and patients lost to follow-up.

To evaluate the rates of inferior vena cava (IVC) filter retrieval and the number of patient's lost to follow-up, before and after the establishment of an IVC filter database and interventional radiology (inserting physician) led follow-up. On the 1st of June 2012, an electronic interventional radiology database was established at our Institution. In addition, the interventional radiology team took responsibility for follow-up of IVC filters. Data were prospectively collected from the database for all patients who had an IVC filter inserted between the 1st June 2012 and the 31st May 2014. Data on patients who had an IVC filter inserted between the 1st of June 2009 to the 31st of May 2012 were retrospectively reviewed. Patient demographics, insertion indications, filter types, retrieval status, documented retrieval decisions, time insitu, trackable events and complications were obtained in the pre-database (n=136) and post-database (n=118) cohorts. Attempted IVC filter retrieval rates were improved from 52.9% to 72.9% (P=0.001) following the establishment of the database. The number of patients with no documented decision (lost to follow-up) regarding their IVC filter reduced from 31 of 136 (23%) to 0 of 118 patients (P=<0.001). There was a non-significant reduction in IVC filter dwell time in the post-database group (113 as compared to 137days, P=0.129). Following the establishment of an IVC filter database and interventional radiology led follow-up, we demonstrate a significant improvement in the attempted retrieval rates of IVC filters and the number of patient's lost to follow-up.

Cost-benefit analysis of establishing an inferior vena cava filter clinic.

Adverse events associated with retrievable inferior vena cava filters (IVCFs) have generated an increased interest in improving IVCF retrieval rates to improve patient safety and quality care. This study aims to demonstrate the cost-benefit of implementing an IVCF clinic to improve patient care in an institution in the United States. An IVCF clinic was established at a single institution in September 2012 and for ten months referring physicians were contacted to facilitate retrieval when appropriate. Additionally, a retrospective review was conducted on filter placements over the eight preclinic months. Cost-benefit analysis was conducted by creating a model, which incorporated the average cost and reimbursement for permanent and retrievable IVCFs. A total of 190 IVCFs (152 retrievable IVCFs and 38 permanent IVCFs) were implanted during the IVCF clinic period. Twenty-nine percent of the retrievable IVCFs were successfully retrieved compared to 10 of 119 retrievable IVCFs placed during the preclinic period (8.4%). Cost-benefit analysis, using the average of the institution's six most common reimbursement schedules, demonstrated an average net financial loss per permanent or retrievable IVCF not removed. However, a net financial gain was realized for each retrievable IVCF removed. The additional hospital cost to maintain the IVCF clinic was offset by removing an additional 3.1 IVCFs per year. An IVCF clinic significantly increases retrieval rates, promotes patient safety, and is economically feasible. Given the adverse event profile of retrievable IVCFs, strategic efforts such as these ultimately can improve quality care for patients with in-dwelling IVCFs.

Strategies to Improve Safety and Outcomes Utilizing Systems-Based Hematologists in IVC Filter Placement and Management in an Academic Medical Center

In large academic institutions, there are multiple disciplines and clinical scenarios that may require placement of inferior vena cava filters (IVCF). Both the Society of Interventional Radiology (SIR) and the American College of Chest Physicians (ACCP) have released guidelines for IVCF use, with the ACCP guidelines being more stringent due to the lack of survival benefit supported by level I data. Several publications have reported high rates of retrievable IVCF complications. In response to these risks and low retrieval rates, the U.S. FDA issued an updated safety alert in 2014 recommending that implanting physicians and clinicians responsible for the ongoing care of patients with retrievable IVCF consider removing the filter as soon as protection from pulmonary embolism is no longer needed.A systems-based hematologist (SBH) plays a vital role in navigating the health care system in the use of therapeutic and device agents that crosses multiple disciplines by implementing evidence-based strategies to improve safety and outcomes. Previously, we used our institution's electronic health record (EHR) system to assist in improving the quality of care and reducing the cost of heparin-induced thrombocytopenia management, blood product utilization in cardiac surgery and pre-procedure management of coagulopathy in chronic liver disease (Greenberg et al. Blood. Vol. 126, No. 23; Abstract 4467).As a first step, the purpose of this study was to report our healthcare system use of IVCF to: a) define the scope of practice and b) to identify areas for improvement. We propose a practical plan that will assist in improving clinician performance, patient education, and acute and chronic management of IVCF in a large healthcare network based on our recent success utilizing EHR to manage complex medical care.A retrospective review of all IVCF placement performed between July 2014 and December 2015 was conducted. A total of 181 IVCF were placed; 26 (14.4%) permanent IVCF, 143 (79.0%) retrievable IVCF, 12 (6.6%) unknown. Mean age at IVCF placement was 59.34 years (range: 19 - 85); 46.4% were male. Ninety-six (53.0%) patients had active cancer. Surgical Services and Medical Services requested IVCF placements in 112 (61.9%) patients and 69 (38.1%) patients, respectively. Only 13 (7.2%) patients had a SBH consultation prior to IVCF placement.Per SIR guidelines, 60.2% (n=109) of IVCF were placed for absolute indications, 15.5% (n=28) for relative indications, 14.4% (n=26) prophylactically and 9.9% (n=18) with no clear indications.Of the 143 retrievable IVCF, 21 patients died during their hospitalization or were discharged to hospice. Of the remaining 122 cases, documentation of the presence of an IVCF was present in 107 (87.7%) discharge summaries, and outlined instructions for filter retrieval were seen in 19 (15.6%) cases. Only 29 (23.8%) IVCF were retrieved at a mean interval of 159 days (range: 4-511 days). Of the 21 patients that had IVCF placed prophylactically, only 7 (33.3%) IVCF were retrieved.While many of the retrievable filters were placed because of an absolute contraindication (n=64) or relative indication for high-risk of complication to anticoagulation (n=13), 37 (48.1%) patients were discharged on a regimen of anticoagulant therapy.We performed a root cause analysis and identified that a lack of awareness of IVCF evidence-based indications could have played a role in filter use patterns and the lack of a structured system for IVCF tracking in some clinical services resulted in poor IVCF retrieval rates. We propose a practical plan requiring clinicians requesting for IVCF to check an evidence-based indication via EHR. When an IVCF is placed, the Anticoagulation and Bleeding Management Specialty Nurse maintains a log of these patients and provides them with an Information Sheet that lists the date, indication and type of IVCF, specific instructions on IVCF retrieval, and a follow-up appointment in the Benign Hematology clinic for anticoagulant management. The Information Sheet is uploaded onto EHR for documentation. In conclusion, we identified the scope of practice and areas that could be improved by the adoption of a centralized and coordinated approach to monitor patients with IVCF. This study demonstrates the potential impact that a SBH has on health care delivery in both the inpatient and outpatient settings. DisclosuresNo relevant conflicts of interest to declare.

A multidisciplinary quality improvement program increases the inferior vena cava filter retrieval rate.

Published reports indicate low retrieval rates for retrievable inferior vena cava (IVC) filters. We performed a historic-controlled study of a 5-year intervention (March 2007 to February 2012) to improve IVC filter retrieval rates at a university medical center serving a rural area. All adults with a retrievable filter placed were included, except those with a life expectancy <6 months. The intervention included initial verbal counseling and printed educational materials, correspondence after discharge, and a hematology consultation. The control group included patients with retrievable filters placed in the 15 months preceding study initiation. In the control group, 116 filters were placed and 27 (23%) were removed, compared to 378 filters placed and 169 (45%) removed during the intervention. Adjusting for patient characteristics, the odds ratio of retrieval during the intervention was 3.03 (95% CI 1.85-4.27) compared to the control period. An intervention including patient education and hematology follow-up appeared to significantly improve IVC filter retrieval rates.

Retrievable inferior vena cava filters in geriatric trauma: Is there an age bias?

BackgroundTrauma patients are at increased risk for developing venous thromboembolic (VTE) disease. The EAST (Eastern Association for the Surgery of Trauma) practice management guidelines identified risk factors for VTE, as well as indications for prophylactic inferior vena cava filters (IVCF). In a 2009 study, our institution found a 26% retrieval rate for IVCF. Lack of retrieval was most consistently due to lack of follow-up. Our study is a follow-up analysis for retrieval rate of IVCF, since the formation of a geriatric trauma service. We anticipated that geriatric trauma patients would have a lower rate of IVCF retrieval compared to the general trauma patient. MethodsOur study population consisted of trauma patients admitted from January 2008 to August 2013, with documented VTE or high risk for VTE with contraindication to anticoagulation. Inclusion criteria: IVCF placed in trauma patients. Exclusion criteria: permanent filters, retrievable filters placed permanently, non-trauma patients, superior vena cava filters and patients who died before discharge. ResultsDuring the study period, 160 trauma patients had an IVCF placed, of which 147 survived and were discharged. Of those patients, 66% (97/147) were planned for retrieval. Overall, the retrieval rate was 34% (33/97). Following age categorization, rates were 47% (30/64) and 9% (3/33) for those <65 and >/=65 years old, respectively. Applying Fisher’s Exact Test to a crosstab of planned retrieval by age category yielded a statistically significant difference, p<0.0005 at alpha=0.05. In the geriatric population with IVCFs not retrieved, 23% (7/30) died and 67% (20/30) were lost to follow-up. ConclusionIVCF plays a critical role in the management of trauma patients with VTE, particularly the geriatric population. Since our 2009 study, we have improved nearly ten percentage points (26% to 34%); however, we exposed an age bias with retrieval rate being lower in patients >/=65 compared to those <65 (9% vs. 47%).

Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach

The option to retrieve inferior vena cava (IVC) filters has resulted in an increase in the utilization of these devices asstopgap measures in patients with relative contraindications to anticoagulation. These retrievable IVC filters, however, are often not retrieved and become permanent. Recent data from our institution confirmed a historically low retrieval rate. Therefore, we hypothesized that the implementation of a new IVC filter retrieval protocol would increase the retrieval rate of appropriate IVC filters at our institution. All consecutive patients who underwent an IVC filter placement at our institution between September 2003 and July 2012 were retrospectively reviewed. In August 2012, a multidisciplinary task force was established, and a new IVC filter retrieval protocol was implemented. Prospective data were collected using a centralized interdepartmental IVC filter registry for all consecutive patients who underwent an IVC filter placement between August 2012 and September 2014. Patients were chronologically categorized into preimplementation (PRE) and postimplementation (POST) groups. Comparisons of outcome measures, including the retrieval rate of IVC filters along with rates of retrieval attempt and technical failure, were made between the two groups. In the PRE and POST groups, a total of 720 and 74 retrievable IVC filters were implanted, respectively. In the POST group, 40 of 74 filters (54%) were successfully retrieved compared with 82 of 720 filters (11%) in the PRE group (P<.001). Furthermore, a greater number of IVC filter retrievals were attempted in the POST group than in the PRE group (66% vs 14%; P< .001). No significant difference was observed between the PRE and POST groups for technical failure (17% vs 18%; P= .9). The retrieval rate of retrievable IVC filters at our institution was significantly increased with the implementation of a new IVC filter retrieval protocol with a multidisciplinary team approach. This improved retrieval rate is possible with minimal dedication of resources and can potentially lead to a decrease in IVC filter-related complications in the future.

A Comprehensive Review of IVC Filters in a Community Tertiary Center

Introduction Retrievable inferior vena cava (IVC) filters are frequently used to prevent pulmonary embolus (PE). Indwelling filters can be associated with complications; timely removal is recommended. In our institution, activated trauma (AT) patients are enrolled in a prospective protocol and tracked by the trauma team, who refer for retrieval as soon as feasible. Interventional radiology maintains a database for traumatic injury (TI) and medical (M) patients and calls them for retrieval at 90 days. To this end, the primary goal of this study was to assess different retrieval patterns between Level 1 and 2 trauma patients, traumatic injury patients not triggering trauma response, and those with medical indications for IVC filters. An additional analysis to examine rates of recurrent thrombosis stratified for filter retention and anticoagulation status was performed.MethodsA retrospective chart review was performed for all patients who had an IVC filter placed between January 2005 and March 2015 at Gundersen Medical Center in La Crosse, WI. Data were collected regarding patients' demographics, risk factors for thrombosis, indications for and details of filter type and placement, post-placement anticoagulation, filter retrieval, and complications arising from filter placement, retention, and retrieval. Patients were divided into AT, TI, and M groups. AT consisted of Level 1 or 2 traumas triggering management by trauma service, TI patients had lesser trauma not triggering trauma team referral, and M patients had filters for medical indications. Those who were lost to follow up or died within 30 days were excluded from all analysis except demographics. Those with permanent filters were omitted from retrieval analysis.ResultsOf the 633 charts reviewed, 4 were excluded for lack of data, 41 were lost to follow-up and 68 died within 30 days. Table 1 summarizes patient category characteristics. Activated trauma patients were younger and had their filter retrieved more often (p<0.0001) than medical or TI patients. The medical population were older, had more risk factors for recurrent thrombosis (median 2 risk factors, range 0-8) and more likely to remain on chronic anticoagulation (27.9%). Those receiving anticoagulation after filter placement had greater rates of recurrent thrombosis (p<0.0001), but more risk factors (p<0.0001)for thrombosis compared to those receiving no anticoagulation. No significant differences were observed in thrombosis-free survival with regard to filter retention. However, rates of DVT after filter placement were 8% higher if the filter was retained rather than removed across all 3 groups(p=0.0011, McNemar's Chi-square).DiscussionHigher rates of DVT in patients with a filter in place are in line with current research associating IVC filters with DVT formation. We observed that patients on lifelong anticoagulation had a higher rate of recurrent thrombosis but increased risk factors for thrombosis, thus identifying a higher risk group for thrombotic events.AT patients in a protocol setting had higher IVC filter retrieval rates compared to the M and IT patients with routine efforts at retrieval. The large gap between M/TI and AT filter retrieval is associated with but not fully explained by the increased risk factors and age of the M and IT groups. Protocolized retrieval of IVC filters increases retrieval rates. Further research is warranted in assessing the impact of protocolized retrieval in the medical and traumatic injury populations.Table 1Patient Category CharacteristicsPatient CategoryN (%)Age (median, range)Retrieval Rate (%)Activated trauma (AT)195 (31%)41 (15-92)78%Traumatic injury (TI)74 (11.8%)44 (16-93)43%Medical (M)360 (57.2%)68 (17-101)38% DisclosuresParsons:Celgene: Speakers Bureau.

Improving Inferior Vena Cava Filter Retrieval Rates with the Define, Measure, Analyze, Improve, Control Methodology

PurposeTo design a sustainable process to improve optional inferior vena cava (IVC) filter retrieval rates based on the Define, Measure, Analyze, Improve, Control (DMAIC) methodology of the Six Sigma process improvement paradigm. Materials and MethodsDMAIC, an acronym for Define, Measure, Analyze, Improve, and Control, was employed to design and implement a quality improvement project to increase IVC filter retrieval rates at a tertiary academic hospital. Retrievable IVC filters were placed in 139 patients over a 2-year period. The baseline IVC filter retrieval rate (n = 51) was reviewed through a retrospective analysis, and two strategies were devised to improve the filter retrieval rate: (a) mailing of letters to clinicians and patients for patients who had filters placed within 8 months of implementation of the project (n = 43) and (b) a prospective automated scheduling of a clinic visit at 4 weeks after filter placement for all new patients (n = 45). The effectiveness of these strategies was assessed by measuring the filter retrieval rates and estimated increase in revenue to interventional radiology. ResultsIVC filter retrieval rates increased from a baseline of 8% to 40% with the mailing of letters and to 52% with the automated scheduling of a clinic visit 4 weeks after IVC filter placement. The estimated revenue per 100 IVC filters placed increased from $2,249 to $10,518 with the mailing of letters and to $17,022 with the automated scheduling of a clinic visit. ConclusionsUsing the DMAIC methodology, a simple and sustainable quality improvement intervention was devised that markedly improved IVC filter retrieval rates in eligible patients.

Social and Demographic Factors Influencing Inferior Vena Cava Filter Retrieval at a Single Institution in the United States.

Retrievable inferior vena cava filters (IVCFs) are associated with long-term adverse events that have increased interest in improving filter retrieval rates. Determining the influential patient social and demographic factors affecting IVCF retrieval is important to personalize patient management strategies and attain optimal patient care. Seven-hundred and sixty-two patients were retrospectively studied who had a filter placed at our institution between January 2011 and November 2013. Age, gender, race, cancer history, distance to residence from retrieval institution, and insurance status were identified for each patient, and those receiving retrievable IVCFs were further evaluated for retrieval rate and time to retrieval. Of the 762 filters placed, 133 were permanent filters. Of the 629 retrievable filters placed, 406 met the inclusion criteria and were eligible for retrieval. Results revealed patients with Medicare were less likely to have their filters retrieved (p = 0.031). Older age was also associated with a lower likelihood of retrieval (p < 0.001) as was living further from the medical center (p = 0.027). Patients who were white and had Medicare were more likely than similarly insured black patients to have their filters retrieved (p = 0.024). The retrieval rate of IVCFs was most influenced by insurance status, distance from the medical center, and age. Race was statistically significant only when combined with insurance status. The results of this study suggest that these patient groups may need closer follow-up in order to obtain optimal IVCF retrieval rates.

1:39 PM; Abstract No. 119 - Cost-effectiveness of establishing an IVC filter clinic for an interventional radiology department

Adverse events associated with optional inferior vena cava filters (IVCFs) have generated an increased interest in improving IVCF retrieval rates. This study aims to demonstrate the cost-effectiveness of implementing an IVCF clinic to improve retrieval rates.