Removal of retrievable vena cava filters in routine practice: a multicenter study

Vena cava filters (VCFs) are used to prevent pulmonary embolism when anticoagulation is contraindicated or in the event of progression of thrombosis despite adequate anticoagulation. Retrievable VCFs provide a potential advantage over permanent VCFs, but the appropriateness of their use and the frequency with which they are removed is not well established.

Objectives

Document the indications for insertion of retrievable VCFs, filter removal in hospital practice.

Methods

Observational study conducted in three academic medical centers. Consecutive patients undergoing retrievable VCF insertion were identified. Clinical data was extracted from the patients' charts and follow up data were obtained from treating physicians after discharge.

Results

300 patients were studied. The indication for filter insertion was acute bleeding (46.1%) or surgery (24.2%) in patients with acute thrombosis, prevention of venous thromboembolism in trauma (13.3%), potential bleeding in patients with deep vein thrombosis (9.1%) thromboembolism while on adequate anticoagulation (5.7%) and other (1.3%).21 (7%) filters were removed. An unsuccessful attempt at retrieval was undertaken in a further 9 (3%) patients.

Conclusions

The use of retrievable VCFs was appropriate, with the possible exception of their prophylactic use in major trauma. The majority of VCFs were not removed, for reasons that are not apparent.     

Outcome and complications of retrievable inferior vena cava filters

The results and risks of retrievable inferior vena cava filters were reviewed. Systematic review identified 6 prospective case series with broad ranges of indications for filters. In these case series, 4 different types of retrievable filters were inserted in 284 patients. The longest reported duration of insertion was 134 days. Among patients in whom percutaneous removal of the filter was attempted, the filter was successfully removed in 144 of 159 (91%). Surgery was necessary to remove the filter from 1 patient (1%), and filters could not be removed because of large trapped thrombi in 14 patients (9%).     

Filtering through the data on retrievable inferior vena cava filters

• Technical success rates with implantation and retrieval of retrievable inferior vena cava filters are high
• Inferior vena cava filters are being used for a wide range of indications
• Systems should be put in place to ensure prompt and effective retrieval of inferior vena cava filters once these are no longer needed

     

Twenty-one-year trends in the use of inferior vena cava filters

BACKGROUND: Improved inferior vena cava (IVC) filters have led to liberalization of the indications for insertion. Increased use, however, has been followed with a potential for unwarranted insertion. There are only sparse data on trends in the use of IVC filters in patients with pulmonary embolism (PE), patients with deep venous thrombosis (DVT) alone, and patients at high risk. We analyzed the National Hospital Discharge Survey (NHDS) database for such trends. METHODS: We used data from the NHDS, which is based on a national probability sample of discharges from short-stay nonfederal hospitals in 50 states and the District of Columbia. The numbers of sampled patients with DVT, PE, and IVC filters were determined from the International Classification of Diseases, Ninth Revision, Clinical Modification codes at discharge. RESULTS: The number of patients who had IVC filters increased from 2000 in 1979 to 49 000 in 1999. In 1999, 45% of IVC filter insertions were in patients with DVT alone, 36% were in patients with PE, and 19% were in patients who presumably were at high risk but did not have DVT or PE listed as a discharge code. The use of IVC filters was more frequent in northeastern states than in western states (P =.01). CONCLUSIONS: The use of IVC filters increased markedly during the last 2 decades in patients with PE, patients with DVT alone, and patients at risk who had neither PE nor DVT. Randomized controlled trials may lead to improved risk stratification and limit the number of unnecessary filter insertions.     

Usefulness of inferior vena cava filters

Inferior vena cava filter placement could be helpful for venous thromboembolism prophylaxis. However its use in Europa is not common. Moreover inferior vena cava filter could reduce morbidity and mortality associated to pulmonary embolism. Patients who could benefit from filter placement should be selected. Indeed filter placement could cause vena cava thrombosis. So as soon as filter has been placed, removal should be programmed.     

Symptomatic inferior vena cava perforation by a retrievable filter: Report of two cases and a literature review

Inferior vena cava filters have been used frequently for decades to prevent pulmonary embolism in medical, surgical and trauma patients. With the advent of temporary or retrievable filters, the use of these filters has increased substantially. However, the enhanced design and attributes that make these devices attractive for short-term benefit and retrieval are not without risk. Two cases of symptomatic inferior vena cava wall penetration are reported - one of which required surgical intervention.     

Increasing use of vena cava filters for prevention of pulmonary embolism

Purpose

To test whether the use of vena cava filters continues to increase in the era of retrievable filters, suggesting that indications for insertion are broadening.

Methods

Data from 1979 through 2006 are from the National Hospital Discharge Survey.

Results

From 1979 through 1984, 17,000 vena cava filters were inserted; 8000 in patients with pulmonary embolism, 4000 in patients with deep venous thrombosis only, and 5000 in patients at risk of pulmonary embolism who had neither. From 1985 through 2006, 803,000 vena cava filters were inserted: 285,000 in patients with pulmonary embolism, 360,000 in patients with deep venous thrombosis only, and 158,000 in patients who had neither. The largest proportional increases in the use of vena cava filters since the introduction of retrievable filters was in patients at risk of pulmonary embolism but who had neither pulmonary embolism nor deep venous thrombosis. The trend toward increased use in this group began before retrievable filters were introduced. There was a 3-fold increase from 2001-2006.

Conclusion

Extensive use of permanent and retrievable vena cava filters in the US indicates liberalization of indications. It would seem that a more discriminate use of vena cava filters would be appropriate at the present time, keeping an open mind for broadened indications as data accrue.     

Bilateral inferior venae cava combined with the persistent left superior vena cava and hemiazygos continuation of left inferior vena cava with drainage into right atrium: A case report

The persistent left superior vena cava (PLSVC) is a common venous abnormality. However, malformation of the bilateral inferior venae cava (IVC) is extremely rare, with an incidence rate of .3%. IVC malformation is associated most frequently with heart defects and isomerism and often has a poor prognosis. We presented a case of vascular malformations in the fetus of bilateral caval veins with the interruption of the left-sided venous return with hemiazygos continuation in presence of a right-sided inferior caval vein. Also noted were the PLSVC and a dilated right heart with a widened pulmonary trunk. In this case, there were no heart defects or chromosomal abnormalities, and the newborn postpartum was in a good condition.     

Long-term results of inferior vena cava filters: experiences in a Japanese population

OBJECTIVE: In this prospective, non-controlled observational study, we evaluated the middle- to long-term results of placement of inferior vena cava (IVC) filter devices in Japanese patients. METHODS AND RESULTS: In 42 Japanese patients with deep vein thrombosis (DVT) or pulmonary thromboembolism (PTE) who underwent percutaneous insertion of IVC filters, follow-up examinations at fixed intervals of 2 years were performed, and the data was evaluated including complications. There were no fatal complications during IVC filter implantation. About 5% of patients with an inserted IVC filter developed symptomatic PTE, another 5% developed asymptomatic PTE. The trapped thrombus was demonstrated in about 22% of the inserted IVC filters. Lower rates of PTE development, occlusion of IVC, and captured thrombus were found in the cases where concurrent use of anticoagulation therapy with filters was used. Trapped thrombi were found in half of IVC filters inserted prophylactically for proximal femoral venous thrombosis. CONCLUSION: These experiences with IVC filters suggest that they are safe and effective for the prevention of PTE in the Japanese population.     

Ins and outs of inferior vena cava filters in patients with venous thromboembolism: the experience at Monash Medical Centre and review of the published reports

Background: Inferior vena cava (IVC) filters are an alternative management strategy to anticoagulation in patients with venous thromboembolism (VTE). However, an IVC filter has its own inherent risks and complications and may not be the best management strategy. The aims of this study were to evaluate our institution’s practice of permanent Vena Tech (B. Braun Medical S.A., Boulogne, France) and retrievable Gunther Tulip (William Cook Europe, Bjaeverskov) IVC filters and to review the available published reports. Methods: Retrospective single centre audit from the medical record. Results: Eighty‐three and 42 patients had a VT and GT filter inserted, respectively. Median age was 57 years for VT and 63 years for GT. The majority (75% for VT and 83% for GT) was inserted for acute VTE and contraindication to anticoagulation. Both filters were efficacious at preventing pulmonary embolism (PE) and there was a low rate of recurrent deep venous thrombosis in both groups. Insertion‐related complications were low in both groups. Of the GT filters (n = 42), 16 were deemed an ongoing requirement, and thus, removal was not planned. In a further six patients, there was insufficient documentation as to why removal was not planned. Removal was attempted in 19 patients and was successful in 11. Failure of removal was as a result of clot in the filter (n = 7) or inability to snare it (n = 1). Conclusions: Both the permanent and retrievable filters are efficacious at preventing PE and are associated with a low complication rate. Planned removal of the GT filter may not be possible in a significant proportion of cases.     

Clinical experience with retrievable vena cava filters for prevention of pulmonary thromboembolism

OBJECTIVES: To evaluate the feasibility, effectiveness and complications of the retrievable vena cava filter [Güther tulip vena cava filter(GTF)] for the prevention of pulmonary thromboembolism in patients with deep vein thrombosis. METHODS: Seventeen patients, 3 males and 14 females, aged 21 to 82 years (mean age 59 +/- 19 years), underwent implantation of GTFs between December 2000 and February 2002 at Mie University Hospital. All patients were treated under diagnoses of deep vein thrombosis with or without pulmonary thromboembolism based on venous ultrasonography, venography or computed tomography. Eleven patients were treated with thrombolysis. RESULTS: Significant thromboembolus was trapped within the filter in 3 of 12 patients. No acute pulmonary thromboembolism occurred during implantation or at retrieval of the GTF. Retrieval of the GTF was attempted in 9 patients, and 8 GTFs were retrieved successfully. Mean interval of the filter implantation was 13.4 +/- 6.3 days and the mean retrieval time was 4.8 +/- 3.2 min. No complications occurred except for one case of minor hemorrhage at the puncture site. CONCLUSIONS: The placement and retrieval of the retrievable vena cava filter was feasible and safe. This filter was also effective for the prevention of pulmonary thromboembolism. This retrievable vena cava filter may be a good first-choice filter for both permanent and temporary use.     

Right heart catheterization in the presence of an inferior vena cava filter.

Inferior vena cava filters are being inserted with increasing frequency. When such patients later require right heart catheterization, brachial or jugular vein access is usually attempted. We describe our experience in 10 consecutive patients using the standard femoral approach, first assessing filter patency and then carefully crossing the filter using a straight guidewire. The right heart chambers were successfully accessed in every case. There were no complications, and in no case did the filter migrate or become dislodged. This technique may prove useful when right heart catheterization is indicated in a patient who has a Greenfield inferior vena cava filter.     

Liver cirrhosis and hepatocellular carcinoma in hepatic vena cava disease, a liver disease caused by obstruction of inferior vena cava

Purpose  Hepatic vena cava disease (HVD), a form of Budd-Chiari syndrome, is caused by the obstruction of hepatic portion of the inferior vena cava. It is a chronic disease characterized by the development of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). As HVD occurred in areas with high incidence of hepatitis B virus (HBV) infection and some patients tested HBsAg positive, it was thought to be the cause of LC and HCC. To assess the pathogenesis of LC or HCC in HVD, a long-term follow-up study was done. Method  Fifty-six patients with HVD diagnosed by ultrasound (US) and confirmed by cavography in 31 and liver biopsy in 34 were followed up for an average of 14.8 ± 9 years. The occurrence of LC was diagnosed by US and/or liver biopsy and that of HCC by US, elevated level of α-fetoprotein, and liver biopsy or fine-needle aspiration cytology, or computed tomographic scan. Other risk factors for LC/HCC such as alcohol use and HBV and hepatitis C virus (HCV) infections were assayed. Results  Forty-four (78.5%) and 6 (10.7%) patients developed cirrhosis and HCC, respectively. LC/HCC occurred more frequently among those who had severe or frequent acute exacerbations (P = 0.017), but it was not related to alcohol use or HBV and HCV infections. Conclusion  HVD is independent risk factors for LC and HCC. Severe and/or recurrent loss of hepatocytes caused by hepatic venous outflow obstruction and/or thrombotic obstruction of small radicals of hepatic and portal veins that occurred during acute exacerbations was considered important in the pathogenesis of LC and HCC in HVD.     

下腔静脉滤器的临床应用及进展

深静脉血栓形成是导致肺栓塞的最主要原因,预防血栓脱落至肺动脉尤为重要.近年来,下腔静脉滤器广泛应用于临床,可以有效预防深静脉血栓形成所致肺栓塞.本文就下腔静脉滤器的发展史、适应证、并发症、临床效果评价及新型下腔静脉滤器等方面展开讨论.