IVC filter: Difference between revisions

(Text replacement - "Category:Pulm" to "Category:Pulmonary")
(Text replacement - "* " to "*")
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==Background==
==Background==
* not meant to treat anything, just prevent PE
*not meant to treat anything, just prevent PE
* >10 differents filters now in use
*>10 differents filters now in use
* most new ones are retrievable
*most new ones are retrievable
* recent marked increase in IVC filter use (since 2003 introduction of retrievable filters)
*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
*prophylactic filter uses expanding in spinal surgery, bariatric surgery and percutaneous endovenous intervention


==Indications==
==Indications==
===American College of Chest Physicians (ACCP)===
===American College of Chest Physicians (ACCP)===
* acute proximal DVT or PE where anticoagulation not possible because of bleeding risk (Grade 1B)
*acute proximal DVT or PE where anticoagulation not possible because of bleeding risk (Grade 1B)
* acute DVT in children with contraindication to anticoagulation (2C)
*acute DVT in children with contraindication to anticoagulation (2C)
* selected patients with DVT/PE despite adequate anticoagualation
*selected patients with DVT/PE despite adequate anticoagualation
* recommend AGAINST placing filter in severe trauma patients for primary VTE prophylaxis (2C)
*recommend AGAINST placing filter in severe trauma patients for primary VTE prophylaxis (2C)
* recommend AGAINST placing in major ortho surgery for primary VTE prophylaxis (2B)
*recommend AGAINST placing in major ortho surgery for primary VTE prophylaxis (2B)
* recommned AGAINST placing filter and anticoagulation for high risk patients with documented DVT/PE (1B)
*recommned AGAINST placing filter and anticoagulation for high risk patients with documented DVT/PE (1B)


===Eastern Association for the Surgery of Trauma (EAST) Guidelines===
===Eastern Association for the Surgery of Trauma (EAST) Guidelines===
''differ from ACCP guidelines in recommend IVC filter for trauma patients immobilized for prolonged period:''
''differ from ACCP guidelines in recommend IVC filter for trauma patients immobilized for prolonged period:''
* severe closed head injury (GCS<8)
*severe closed head injury (GCS<8)
* spinal cord injury (paraplegia, quadriplegia)
*spinal cord injury (paraplegia, quadriplegia)
* complex pelvic fractures with long bone fractures
*complex pelvic fractures with long bone fractures
* multiple long bone fractures
*multiple long bone fractures


==Complications==
==Complications==
===Early===
===Early===
* puncture site hematoma
*puncture site hematoma
* malposition or tilting of device
*malposition or tilting of device
* delivery system complications (guidewire mishap)
*delivery system complications (guidewire mishap)
* failure to open completely
*failure to open completely


===Late===
===Late===
* many retrievable IVC filters are placed with no systems mechanism for the timely removal placing patients are increased risk of delays complications:
*many retrievable IVC filters are placed with no systems mechanism for the timely removal placing patients are increased risk of delays complications:
* tilting of device (making it less effective)
*tilting of device (making it less effective)
* migration of filter (to SVC or heart)
*migration of filter (to SVC or heart)
* fracturing of structs with embolization
*fracturing of structs with embolization
* IVC perforation
*IVC perforation
** retroperitoneal hematoma
**retroperitoneal hematoma
** aortic pseudoaneurysms
**aortic pseudoaneurysms
** duodenal perforation
**duodenal perforation
** penetration of pancreas, iliopsoas, vertebral body
**penetration of pancreas, iliopsoas, vertebral body


==Evidence Based Outcomes==
==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
*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'''
*'''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==
==See Also==
Line 48: Line 48:


==References==
==References==
* 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
*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
* 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.
*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.
* 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
*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
<references/>
<references/>


[[Category:Pulmonary]]
[[Category:Pulmonary]]
[[Category:Vascular]]
[[Category:Vascular]]

Revision as of 15:22, 8 July 2016

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)

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

Eastern Association for the Surgery of Trauma (EAST) Guidelines

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

  • severe closed head injury (GCS<8)
  • spinal cord injury (paraplegia, quadriplegia)
  • complex pelvic fractures with long bone fractures
  • multiple long bone fractures

Complications

Early

  • puncture site hematoma
  • malposition or tilting of device
  • delivery system complications (guidewire mishap)
  • 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:
  • tilting of device (making it less effective)
  • migration of filter (to SVC or heart)
  • fracturing of structs with embolization
  • 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

References

  • 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
  • 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.
  • 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