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Rotellar F, Martí-Cruchaga P, Baixauli J, Olavide I, Bilbao JI. Minimally Invasive Removal of Perforating Cava Filter: Retroperitoneoscopic Approach. J Am Coll Surg 2020; 231:e11-e14. [PMID: 32947037 DOI: 10.1016/j.jamcollsurg.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Fernando Rotellar
- Departments of General Surgery, Pamplona, Spain; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.
| | - Pablo Martí-Cruchaga
- Departments of General Surgery, Pamplona, Spain; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Jorge Baixauli
- Departments of General Surgery, Pamplona, Spain; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Isidro Olavide
- Anesthesiology, Pamplona, Spain; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - José I Bilbao
- Radiology, University of Navarra, Pamplona, Spain; Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
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Trends in inferior vena cava filter placement and retrieval at a tertiary care institution. J Vasc Surg Venous Lymphat Disord 2019; 7:405-412. [DOI: 10.1016/j.jvsv.2018.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 11/10/2018] [Indexed: 11/22/2022]
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Brown JD, Raissi D, Han Q, Adams VR, Talbert JC. Vena Cava Filter Retrieval Rates and Factors Associated With Retrieval in a Large US Cohort. J Am Heart Assoc 2017; 6:JAHA.117.006708. [PMID: 28871041 PMCID: PMC5634307 DOI: 10.1161/jaha.117.006708] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Retrieval of vena cava filters (VCFs) is important for safety as complications increase with longer dwell times. This study assessed VCF retrieval rates and factors associated with retrieval in a national cohort. Methods and Results VCFs were identified by procedural codes from an administrative claims database. Patients were identified who had a VCF placement during a hospitalization from a national commercial administrative claims database. Indications for VCF placement were identified as pulmonary embolism with or without deep vein thrombosis, deep vein thrombosis only, or prophylactic. Patient demographic and clinical characteristics were included in proportional hazard regression models to find associations with early (90‐day) and 1‐year VCF retrieval. Initiation of anticoagulation and the correlation between time‐to‐retrieval and time‐to‐initiation of anticoagulation were observed. Of 54 766 patients receiving a VCF, 36.9% had pulmonary embolism, 43.9% had deep vein thrombosis only, and 19.2% had no apparent venous thromboembolism present. Over the 1 year of follow‐up, the cumulative incidence of VCF retrieval was 18.4%. Retrieval increased over time from a low of 14.0% in 2010 up to ≈24% in 2014. In adjusted time‐to‐event models, increasing age, differing regions, and some comorbidities were associated with poorer retrieval rates. Initiation of anticoagulation was poorly correlated with retrieval, with anticoagulation preceding retrieval by a median of 51 days while those without retrieval had a median of 278 days of exposure to anticoagulation. Conclusions VCF retrieval increased over the study period but remained suboptimal and was weakly correlated with anticoagulation initiation.
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Affiliation(s)
- Joshua D Brown
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Driss Raissi
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Kentucky College of Medicine, Lexington, KY
| | - Qiong Han
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Kentucky College of Medicine, Lexington, KY
| | - Val R Adams
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
| | - Jeffery C Talbert
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
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Trapped by Controversy: Inferior Vena Cava Filters and the Law. J Vasc Interv Radiol 2017; 28:886-888. [DOI: 10.1016/j.jvir.2017.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/15/2022] Open
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Shah M, Alnabelsi T, Patil S, Reddy S, Patel B, Lu M, Chandorkar A, Perelas A, Arora S, Patel N, Jacobs L, Eiger GG. IVC filters-Trends in placement and indications, a study of 2 populations. Medicine (Baltimore) 2017; 96:e6449. [PMID: 28328857 PMCID: PMC5371494 DOI: 10.1097/md.0000000000006449] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Inferior vena cava filter (IVCF) placement appears to be expanding over time despite absence of clear directing evidence.Two populations were studied. The first population included patients who received an IVCF between January 2005 and August 2013 at our community hospital center. Demographic information, indications for placement, and retrieval rate was recorded among other variables. The second population comprised of patients receiving an IVCF from 2005 to 2012 according to the Nationwide Inpatient Sample (NIS) using ICD-9CM coding. Patients were divided into 2 groups based on the year of admission for comparison, that is, first group from 2005 to 2008 and the second from 2009 to 2012. In addition, we analyzed annual trends in filter placement, acute venothromboembolic events (VTE) and several underlying comorbidities within this population.At our center, 802 IVCFs were placed (55.2% retrievable); 34% for absolute, 61% for relative, and 5% for prophylactic indications. Major bleeding (27.5%), minor self-limited bleeding (13.7%), and fall history (11.2%) were the commonest indications. Periprocedural complication rate was 0.7%, and filter retrieval rate was 7%. The NIS population (811,487 filters) saw a decline in IVCF placement after year 2009, following an initial uptrend (Ptrend < 0.01). IVCF use among patients with neither acute VTE nor bleeding among prior VTE saw a 3-fold absolute reduction from 2005 to 2012 (33,075-11,655; Ptrend < 0.01). Patients from 2009 to 2012 were more likely to be male and had higher rates of acute VTE, thrombolytic use, cancer, bleeding, hypotension, acute cardiorespiratory failure, shock, prior falls, blood product transfusion, hospital mortality including higher Charlson comorbidity scores. The patients were younger, had shorter length of stay, and were less likely to be associated with strokes including hemorrhagic or require ventilator support. Prior falls (adjusted odds ratio-aOR 2.8), thrombolytic use (aOR 1.76), and shock (aOR 1.45) were most predictive of IVCF placement between 2009 and 2012 on regression analysis.Recent trends suggest that a higher proportion of patients receive temporary IVCF, for predominantly relative indications. Nationally, the number of filters being placed is decreasing, especially among those who did not experience acute VTE or bleeding events. Prior falls, thrombolytic therapy, and shock were most predictive of IVCF placement in latter half of the study period.
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Affiliation(s)
- Mahek Shah
- Department of Cardiology, Lehigh Valley Hospital, Allentown
| | | | | | - Shilpa Reddy
- Department of Radiology, Einstein Medical Center, Philadelphia, PA
| | - Brijesh Patel
- Department of Cardiology, Lehigh Valley Hospital, Allentown
| | | | | | | | | | - Nilay Patel
- Saint Peter's University Hospital, New Brunswick, NJ
| | - Larry Jacobs
- Department of Cardiology, Lehigh Valley Hospital, Allentown
| | - Glenn G. Eiger
- Division of Pulmonary and Critical Care, Einstein Medical Center, Philadelphia, PA
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You S, Won JH, Oh CK, Lee SH, Shim JJ, Kim J. Transjugular Access for Endovascular Treatment of Immature Autogenous Arteriovenous Fistulae. J Vasc Interv Radiol 2016; 27:1878-1884. [PMID: 27686398 DOI: 10.1016/j.jvir.2016.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/17/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the feasibility and outcome of transjugular access for endovascular treatment of immature arteriovenous fistulae (AVFs). MATERIALS AND METHODS Between August 2013 and January 2016, 90 patients (mean age, 64.5 y ± 12.8) underwent endovascular treatment of immature AVFs via transjugular access. The mean age of fistulae was 3.3 months ± 1.8. Total procedure time and technical and clinical success rates of endovascular procedures were assessed. Primary and secondary patency rates were calculated according to the Kaplan-Meier method, and complications were assessed. RESULTS All patients had inflow lesions, among which 19 (21.1%) had occlusions. The juxtaanastomotic segment was the most common site (44.3%). Transjugular access was successful in 83 patients (92.2%), and 7 required additional standard or transarterial access. The mean procedure time was 36.5 minutes. Technical and clinical success rates were 98.9% and 90.5%, respectively. Mean primary and secondary patency durations were 14.3 months ± 1.7 and 31.0 months ± 0.7, respectively. Primary patency rates at 3, 6, and 12 months were 84.4%, 67.3%, and 48.8%, respectively. Secondary patency rates at 6 and 18 months were 98.6% and 95.5%, respectively. Venous rupture occurred as a result of balloon inflation in 9 patients (10%), and was managed by balloon tamponade. There were no complications related to transjugular access during a mean follow-up period of 12.6 months. CONCLUSIONS Transjugular access for angioplasty of immature AVFs is feasible and safe. Potential problems associated with access in the outflow vein could be avoided by transjugular access.
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Affiliation(s)
- Seulgi You
- Departments of Radiology, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea
| | - Je Hwan Won
- Departments of Radiology, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea
| | - Chang-Kwon Oh
- Surgery, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea
| | - Su Hyung Lee
- Surgery, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea
| | - Jong Joon Shim
- Departments of Radiology, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea
| | - Jinoo Kim
- Departments of Radiology, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea.
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Tao MJ, Montbriand JM, Eisenberg N, Sniderman KW, Roche-Nagle G. Temporary inferior vena cava filter indications, retrieval rates, and follow-up management at a multicenter tertiary care institution. J Vasc Surg 2016; 64:430-437. [DOI: 10.1016/j.jvs.2016.02.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/06/2016] [Indexed: 10/22/2022]
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Kuy S, Dua A, Lee CJ, Patel B, Desai SS, Dua A, Szabo A, Patel PJ. National trends in utilization of inferior vena cava filters in the United States, 2000-2009. J Vasc Surg Venous Lymphat Disord 2014; 2:15-20. [DOI: 10.1016/j.jvsv.2013.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/16/2013] [Accepted: 08/23/2013] [Indexed: 10/25/2022]
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El-Daly I, Reidy J, Culpan P, Bates P. Thromboprophylaxis in patients with pelvic and acetabular fractures: A short review and recommendations. Injury 2013; 44:1710-20. [PMID: 23816168 DOI: 10.1016/j.injury.2013.04.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 04/07/2013] [Accepted: 04/28/2013] [Indexed: 02/02/2023]
Abstract
The management of thromboprophylaxis in patients with pelvic and acetabular fractures remains a highly controversial topic within the trauma community. Despite anticoagulation, venous thromboembolism (VTE) remains the most common cause of surgical morbidity and mortality in this high-risk patient group. Although various thromboprophylactic regimes are employed, evidence relating to the most effective method remains unclear. Controversies surrounding screening, the use of prophylactic inferior vena cava filters (IVCF) and chemothromboprophylaxis in polytraumatised patients, particularly those with pelvic and acetabular fractures, form the basis of considerable debate. With the absence of a well-designed clinical trial and the presence of ongoing controversies within the literature, this review will explore current treatment options available to trauma surgeons and highlight differing scientific opinions, providing an update on the role of screening and current available preventative measures. We cover existing as well as recent advances in chemical thromboprophylactic agents and discuss external mechanical compression devices, the usefulness of serial duplex ultrasonography and the role of extended chemothromboprophylaxis on discharge. The evidence behind prophylactic IVCF is also considered, along with reported complication profiles. We conclude with a proposed protocol for use in major trauma centres, which can form the basis of local policy for the prevention of VTE in trauma patients with pelvic and acetabular fractures.
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Affiliation(s)
- Ibraheim El-Daly
- The Royal London Hospital, Barts Health NHS Trust, Department of Trauma and Orthopaedic Surgery, Whitechapel, London E1 1BB, UK.
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Kalva SP, Athanasoulis CA. Variation in the use of inferior vena cava filters for VTE. Nat Rev Cardiol 2013; 10:368-70. [DOI: 10.1038/nrcardio.2013.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wood EA, Malgor RD, Gasparis AP, Labropoulos N. Reporting the impact of inferior vena cava perforation by filters. Phlebology 2013; 29:471-5. [DOI: 10.1177/0268355513491723] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Perforation of the inferior vena cava by filters struts is a known complication. The goal of our review is to assess the impact of inferior vena cava perforation by filters based on an open, voluntary national database. Methods We reviewed 3311 adverse events of inferior vena cava filters reported in Manufacturer and User Facility Device Experience database from January 2000 to June 2011. Outcomes of interest were incidence of inferior vena cava perforation, type of filter, clinical presentation, and management of the perforation, including retrievability rates. Results Three hundred ninety-one (12%) cases of inferior vena cava perforation were reported. The annual distribution of inferior vena cava perforation was 35 cases (9%), varying from seven (2%) to 70 (18%). A three-fold increment in the number of adverse events related to inferior vena cava filters has been noted since 2004. Wall perforation as an incidental finding was the most common presentation ( N = 268, 69%). Surrounding organ involvement was found in 117 cases (30%), with the aorta being the most common in 43 cases (37%), followed by small bowel in 36 (31%). Filters were retrieved in 97 patients (83%) regardless of wall perforation. Twenty-five (26%) cases required an open procedure to remove the filter. Neither major bleeding requiring further intervention nor mortality was reported. Conclusions Inferior vena cava perforation by filters remains stable over the studied years despite increasing numbers of adverse events reported. The majority of filters involved in a perforation were retrievable. Filter retrieval, regardless of inferior vena cava wall perforation, is feasible and must be attempted whenever possible in order to avoid complications.
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Affiliation(s)
- Emily A Wood
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Rafael D Malgor
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Antonios P Gasparis
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Nicos Labropoulos
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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A “fall-back” technique for difficult inferior vena cava filter retrieval. J Vasc Surg 2012; 56:1629-33. [DOI: 10.1016/j.jvs.2012.02.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 02/22/2012] [Accepted: 02/23/2012] [Indexed: 11/22/2022]
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Spate K, Aziz F, Sumpio BE. The use of retrievable inferior vena cava filters in the trauma population. Int J Angiol 2012; 17:23-6. [PMID: 22477367 DOI: 10.1055/s-0031-1278275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To determine if the use of retrievable filters resulted in an increase in the placement of inferior vena cava (IVC) filters in trauma patients. DESIGN All patients who underwent IVC filter placement at Yale-New Haven Hospital, New Haven, Connecticut, USA between the years 1999 and 2004. SETTING Academic, level 1 trauma centre. PATIENTS Included in the present study were 202 trauma patients and 676 nontrauma patients. INTERVENTION IVC filter placement. MAIN OUTCOME MEASURE Demographics, indications, complication rates and type of IVC filters placed in trauma patients versus nontrauma patients were evaluated. RESULTS The present study determined 45.4% (n=92) of trauma patients undergoing IVC filter placement were younger than 40 years of age, compared with 7.8% (n=53) of nontrauma patients. The most common indication for IVC filter placement in trauma patients was prophylaxis (n=162, 80.2%), while in the nontrauma patients only 11.4% (n=77) of patients underwent prophylactic filter placement. The number of retrievable filters used in trauma patients increased from 46.7% in 2001, the year they became available, to 78.9% in 2004. The use of retrievable filters similarly increased in the nontrauma population from 35.9% in 2001 to 78.3% in 2004. Approximately 24% of the patients that underwent IVC filter placement at Yale-New Haven Hospital were categorized as trauma patients. The complication rate for this time period was 0.5% (n=1) in the trauma population versus 3.7% (n=26) in the nontrauma population. CONCLUSION The overall number of IVC filters placed in trauma patients did not dramatically increase with the introduction of retrievable filters, suggesting that the indications for the use of IVC filters have not changed.
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Affiliation(s)
- Kristina Spate
- Yale University School of Medicine, Department of Vascular Surgery, New Haven, Connecticut, USA
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Yeh CH, Wu YM, Toh CH, Chen YL, Wong HF. A safe and efficacious alternative: sonographically guided internal jugular vein puncture for intracranial endovascular intervention. AJNR Am J Neuroradiol 2012; 33:E7-E12. [PMID: 22158929 DOI: 10.3174/ajnr.a2416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Transvenous interventions for intracranial vascular lesions are usually performed via venous access of a femoral vein puncture. However, the transjugular route is an alternative with a shorter and less tortuous vascular access for intracranial lesions. Although puncture of the internal jugular vein is generally believed to be too dangerous owing to potential hazardous complications, the safety of the sonographically guided retrograde internal jugular vein puncture technique for intracranial intervention has not been fully evaluated in the English literature. We present our experience with a total of 44 transjugular intervention procedures between April 1999 and June 2010. We believe sonographically guided internal jugular vein puncture is a safe and efficacious technique for establishing transvenous access for an intracranial endovascular intervention.
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Affiliation(s)
- C-H Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
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Meisner RJ, Labropoulos N, Gasparis AP, Lampl J, Xu M, Tassiopoulos AK. Review of indications and practices of vena caval filters at a large university hospital. Vasc Endovascular Surg 2011; 46:21-5. [PMID: 22156155 DOI: 10.1177/1538574411422274] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vena caval filter (VCF) use has been increasing in recent years. Prophylactic VCF placement has been applied liberally in high-risk patients. METHODS Consecutive patients with VCF placement over a 2-year period at a university hospital were reviewed. RESULTS A total of 244 patients underwent VCF placement in 2 years. Of all, 54% of the patients had the VCF placed for an absolute indication, 14% for a relative indication, and 32% for prophylaxis. Only 14 (9%) of the retrievable filters were removed. Eight patients had a complication of VCF placement; there were no complications of filter retrieval. Vena caval filter placement for prophylaxis alone was 57% from the division of trauma and surgical critical care, 18.3% from interventional radiology department, and 5.2% from the division of vascular surgery. CONCLUSIONS This study indicates that many VCFs are placed for prophylaxis. A low percentage of VCFs was retrieved. This may be the practice at many other large university-based hospitals, necessitating strategies for reducing their placement.
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Affiliation(s)
- Robert J Meisner
- Vascular Surgery Division, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY 11794, USA.
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Dossett LA, Adams RC, Cotton BA. Unwarranted National Variation in the Use of Prophylactic Inferior Vena Cava Filters After Trauma: An Analysis of the National Trauma Databank. ACTA ACUST UNITED AC 2011; 70:1066-70; discussion 1070-1. [DOI: 10.1097/ta.0b013e31821282d5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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O'Keeffe T, Thekkumel JJ, Friese S, Shafi S, Josephs SC. A Policy of Dedicated Follow-Up Improves the Rate of Removal of Retrievable Inferior Vena Cava Filters in Trauma Patients. Am Surg 2011. [DOI: 10.1177/000313481107700131] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Retrievable Inferior Vena Cava Filters (IVCF) for prophylaxis against pulmonary embolus have been associated with low rates of removal. Strategies for improving the rates of retrieval have not been described. We hypothesized that a policy of dedicated follow-up would achieve a higher rate of filter removal. Trauma and Nontrauma patients who had a retrievable IVCF placed during 2006 were identified. A protocol existed for trauma patients with chart stickers, arm bracelets, and dedicated follow-up by nurse practitioners from three trauma teams. No protocol existed for nontrauma patients. Statistical analysis was performed using χ2 analysis or analysis of variance. One hundred sixty-seven retrievable IVCFs were placed over 12 months; 91 in trauma patients and 76 in nontrauma patients. Trauma patients were more likely to have their IVCF removed than nontrauma patients, 55 per cent versus 19 per cent, P < 0.001. There were differences between the three trauma teams, with removal rates of 44 per cent, 42 per cent, and 86 per cent respectively ( P < 0.05). On multivariate analysis young age and trauma patient status were independent predictors of filter removal. A policy of dedicated follow-up of patients with IVCFs can achieve significantly higher rates of filter removal than have been previously reported. Similar policies should be adopted by all centers placing retrievable IVCFs to maximize retrieval rates.
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Affiliation(s)
- Terence O'Keeffe
- Division of Trauma, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Joby J. Thekkumel
- Division of Trauma, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Susan Friese
- Division of Trauma, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Shellie C. Josephs
- Department of Radiology, University of Texas Southwestern Medical School, Dallas, Texas
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A systematic method for follow-up improves removal rates for retrievable inferior vena cava filters in a trauma patient population. ACTA ACUST UNITED AC 2010; 69:866-9. [PMID: 20938273 DOI: 10.1097/ta.0b013e3181effe2a] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Retrievable inferior vena cava filters (rIVCF) reduce the short-term risk of pulmonary embolism without the filter and inferior vena cava (IVC) thrombosis that have been reported with the use of permanent filters. Studies have shown that most rIVCFs are not removed, leaving patients at risk for thrombotic complications of rIVCF retention. We hypothesize that the application of a systematic follow-up for rIVCF will improve filter removal rates, providing patients short-term prophylaxis from pulmonary embolism whereas avoiding complications of permanent filter retention. METHODS The trauma registry of a Level I trauma center was queried to identify patients who underwent placement of IVCFs between January 1, 2003, and June 30, 2008. The medical records were reviewed and details of the patient's injuries, indications for filter placement, repositioning, and retrieval were collected. Radiographic images were reviewed to confirm ultimate filter retention or removal. RESULTS Between January 1, 2003, and June 30, 2008, rIVCFs were placed in 118 patients, 44% had known venous thromboembolic event. Three patients died before rIVCFs could be considered for extraction, leaving 115 patients for evaluation. Filters were removed in 80 patients (70%) overall. Of the 35 patients in whom filters were not removed, 11 were lost to follow-up, 4 failed removal attempts, and 20 had indications for filter retention. The rIVCFs were retrieved in 75% of patients not lost to follow-up and 92% of patients who did not have contraindications for filter removal. CONCLUSION A dedicated system for following-up patients with rIVCFs markedly improves removal rates of retrievable filters.
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Becher RD, Corriere MA, Edwards MS, Godshall CJ. Late erosion of a prophylactic Celect IVC filter into the aorta, right renal artery, and duodenal wall. J Vasc Surg 2010; 52:1041-4. [DOI: 10.1016/j.jvs.2010.04.065] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 04/23/2010] [Accepted: 04/23/2010] [Indexed: 02/02/2023]
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Aziz F, Comerota AJ. Inferior Vena Cava Filters. Ann Vasc Surg 2010; 24:966-79. [DOI: 10.1016/j.avsg.2010.03.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 03/21/2010] [Indexed: 10/19/2022]
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Moore PS, Andrews JS, Craven TE, Davis RP, Corriere MA, Godshall CJ, Edwards MS, Hansen KJ. Trends in vena caval interruption. J Vasc Surg 2010; 52:118-125.e3; discussion 125-6. [DOI: 10.1016/j.jvs.2009.09.067] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 09/01/2009] [Accepted: 09/05/2009] [Indexed: 11/29/2022]
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Comparison of the Recovery and G2 Filter as Retrievable Inferior Vena Cava Filters. J Vasc Interv Radiol 2009; 20:1193-9. [DOI: 10.1016/j.jvir.2009.05.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 03/31/2009] [Accepted: 05/28/2009] [Indexed: 11/24/2022] Open
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Abstract
Vena cava filters were developed as a method of preventing pulmonary embolism (PE) in patients with venous thromboembolism (VTE) at risk for bleeding from therapeutic anticoagulation. However, the long-term complications of filter placement, such as caval thrombosis, have mitigated some of the benefits, particularly in those patients with only a temporary contraindication to anticoagulation. Retrievable filters were designed to avoid the long-term risks of a permanent filter while still providing short-term protection against PE. As a result, their use has expanded from patients with known thrombosis to those without VTE who are at high risk for developing PE. In this review, we discuss the different types of retrievable filters, indications for their placement, complications that can occur during and after placement, and their use as prophylaxis in surgical patients. Although the use of retrievable filters in patients with known VTE is clear, further studies are needed to establish their prophylactic efficacy in the surgical patient. Until this evidence is available, we recommend that retrievable filters should be used only in patients with acute VTE who are at risk for recurrent thromboembolism and have a transient risk for bleeding.
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Affiliation(s)
- Marianne Tschoe
- Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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