Retrieval of Recovery IVC Filter After 1,463-Day Implantation

[Who is responsible for the removal of inferior vena cava filters?]

The fact that many inferior vena cava filters (IVCF) in trauma patients are not being removed has been described numerous times in the literature, but nobody really gives a reason why. This case presents a young patient who prophylactically received an optional IVCF after sustaining severe multitrauma. He had a failed retrieval 8 weeks post insertion and consequently was lost to follow-up before a second removal attempt was performed. Institutions inserting IVCF should establish guidelines for following up patients receiving prophylactic IVCF.

[Vena cava filters in trauma patients]

BACKGROUND

The introduction of removable inferior vena cava filters (IVCF) has created new options for the prevention of pulmonary embolisms in surgical trauma patients. We have observed increasing use in trauma patients.

PATIENTS AND METHODS

A retrospective analysis was carried out of 49 trauma patients out of 85 who received IVCFs at our level 1 trauma centre in 2008.

RESULTS

The indications for IVCF placement were multiple trauma in 33 patients, severe head injury in 13 and spinal injury in 3 patients. Of the patients 34 underwent successful removal, 11 (22%) patients had had no retrieval attempt by December 2009 and attempts at removal were unsuccessful in 3 patients. The mean age of the patients was 33.3 years.

CONCLUSION

In 2008 the vast majority of IVCFs were inserted for prophylaxis in trauma patients. To increase the number of retrieved IVCFs, responsibility for the removal should be clarified in every hospital. The indications, advantages, safety and also the design of IVCFs are still under debate. A randomized controlled trial is needed to determine the appropriate use and indications for this potentially useful device in trauma patients.