IVC filter

Background

• not meant to treat anything, just prevent PE
• >10 differents filters now in use
• most new ones are retrievable
• recent marked increase in IVC filter use (since 2003 introduction of retrievable filters)
• prophylactic filter uses expanding in spinal surgery, bariatric surgery and percutaneous endovenous intervention

Indications

American College of Chest Physicians (ACCP)

1. acute proximal DVT or PE where anticoagulation not possible because of bleeding risk (Grade 1B)
2. acute DVT in children with contraindication to anticoagulation (2C)
3. selected patients with DVT/PE despite adequate anticoagualation
4. recommend AGAINST placing filter in severe trauma patients for primary VTE prophylaxis (2C)
5. recommend AGAINST placing in major ortho surgery for primary VTE prophylaxis (2B)
6. recommned AGAINST placing filter and anticoagulation for high risk patients with documented DVT/PE (1B)

Eastern Association for the Surgery of Trauma (EAST) Guidelines

• they differ from ACCP guidelines in:
  • recommend IVC filter for trauma patients immobilized for prolonged period:

1. severe closed head injury (GCS<8)
2. spinal cord injury (paraplegia, quadriplegia)
3. complex pelvic fractures with long bone fractures
4. multiple long bone fractures

Complications

Early

1. puncture site hematoma
2. malposition or tilting of device
3. delivery system complications (guidewire mishap)
4. failure to open completely

Late

• • many retrievable IVC filters are placed with no systems mechanism for the timely removal placing patients are increased risk of delays complications:

1. tilting of device (making it less effective)
2. migration of filter (to SVC or heart)
3. fracturing of structs with embolization
4. IVC perforation
   • • retroperitoneal hematoma
     • aortic pseudoaneurysms
     • duodenal perforation
     • penetration of pancreas, iliopsoas, vertebral body

Evidence Based Outcomes

• the one randomized controlled study of IVC filters failed to show a mortality difference (out to 8yrs), although the IVC filter group did have a lower incidence of PE
• A clinical trial of vena cava filters in the prevention of pulmonary embolism in patients with proximal deep vein thrombosis. N Engl J Med. 1998 Feb 12;338(7):409-15

See Also

• Pulmonary Embolism

References

1. Rogers FB et al. Venous Thromboembolism: Role of Vena Cava Filters in Prophylaxis and Treatment of Pulmonary Embolism. J Trauma. 53(1):142-162;2002
2. Guyatt GH et al. Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141:7-47.
3. A clinical trial of vena cava filters in the prevention of pulmonary embolism in patients with proximal deep vein thrombosis. N Engl J Med. 1998 Feb 12;338(7):409-15