IVC filter: Difference between revisions
Ostermayer (talk | contribs) (Text replacement - "Category:Pulm" to "Category:Pulmonary") |
Neil.m.young (talk | contribs) (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== | ||
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==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