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)

• acute proximal DVTor PE where anticoagulation not possible because of bleeding risk (Grade 1B)
• acute DVTin 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

• Pulmonary Embolism

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

Authors

Ross Donaldson