1
|
Alshaqaq HM, Al-Sharydah AM, Alshahrani MS, Alqahtani SM, Amer M. Prophylactic Inferior Vena Cava Filters for Venous Thromboembolism in Adults With Trauma: An Updated Systematic Review and Meta-Analysis. J Intensive Care Med 2023; 38:491-510. [PMID: 36939472 DOI: 10.1177/08850666231163141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Background: Trauma is an independent risk factor for venous thromboembolism (VTE). Due to contraindications or delay in starting pharmacological prophylaxis among trauma patients with a high risk of bleeding, the inferior vena cava (IVC) filter has been utilized as alternative prevention for pulmonary embolism (PE). Albeit, its clinical efficacy has remained uncertain. Therefore, we performed an updated systematic review and meta-analysis on the effectiveness and safety of prophylactic IVC filters in severely injured patients. Methods: Three databases (MEDLINE, EMBASE, and Cochrane) were searched from August 1, 2012, to October 27, 2021. Independent reviewers performed data extraction and quality assessment. Relative risk (RR) at 95% confidence interval (CI) pooled in a randomized meta-analysis. A parallel clinical practice guideline committee assessed the certainty of evidence using the GRADE approach. The outcomes of interest included VTE, PE, deep venous thrombosis, mortality, and IVC filter complications. Results: We included 10 controlled studies (47 140 patients), of which 3 studies (310 patients) were randomized controlled trials (RCTs) and 7 were observational studies (46 830 patients). IVC filters demonstrated no significant reduction in PE and fatal PE (RR, 0.27; 95% CI, 0.06-1.28 and RR, 0.32; 95% CI, 0.01-7.84, respectively) by pooling RCTs with low certainty. However, it demonstrated a significant reduction in the risk of PE and fatal PE (RR, 0.25; 95% CI, 0.12-0.55 and RR, 0.09; 95% CI, 0.011-0.81, respectively) by pooling observational studies with very low certainty. IVC filter did not improve mortality in both RCTs and observational studies (RR, 1.44; 95% CI, 0.86-2.43 and RR, 0.63; 95% CI, 0.3-1.31, respectively). Conclusion: In trauma patients, moderate risk reduction of PE and fatal PE was demonstrated among observational data but not RCTs. The desirable effect is not robust to outweigh the undesirable effects associated with IVC filter complications. Current evidence suggests against routinely using prophylactic IVC filters.
Collapse
Affiliation(s)
- Hassan M Alshaqaq
- Emergency Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz M Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed S Alshahrani
- Department of Emergency and Critical Care, King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saad M Alqahtani
- Department of Orthopedics surgery, 48102King Fahd Hospital of the University, 48023Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Marwa Amer
- Medical/Critical Pharmacy Division, 37852King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,College of Medicine, 101686Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Sridharan N, Williams AO, Rojanasarot S, Anderson N, Wifler W, Jaff MR, Chaer R. Cost Burden and Cost Influencers of Inferior Vena Cava Filter Placement and Retrieval among Medicare Beneficiaries with Acute Venous Thromboembolism. J Vasc Interv Radiol 2023; 34:164-172.e2. [PMID: 36265817 DOI: 10.1016/j.jvir.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To examine the frequency, costs, and cost influencers of inferior vena cava filters (IVCFs) placements and retrievals among a national sample of patients using Medicare data. MATERIALS AND METHODS This retrospective cohort study used the U.S. Medicare 100% database, a nationally representative sample of all U.S. patients aged ≥65 years, from 2014 through 2020. Procedures and clinical characteristics were identified from the diagnosis and procedure codes on Medicare claims. Beneficiaries aged ≥65 years with newly diagnosed venous thromboembolism (VTE) were identified and followed to obtain data on IVCF placements and retrievals. Data on the costs of the index IVCF procedures and any subsequent IVCF placements and retrievals were obtained. Multivariate models were used to estimate the impact of patient and clinical characteristics on costs. RESULTS Among 501,216 patients with newly diagnosed VTE, 4,995 (1%) received an IVCF placement; of these, 1,215 (24.3%) had a retrieval procedure. Beneficiaries with IVCF placements and retrievals differed from a demographic and clinical perspective than from those without. Costs varied by the site of service, VTE acuity, and VTE type. Cost influencers included age, race, census region, service location, and VTE type. CONCLUSIONS IVCF placement costs were driven by baseline patient characteristics (age, race, geographic residence, acute VTE diagnosis, and inpatient site of service), whereas retrieval costs were driven by age and deep vein thrombosis diagnosis. Strategies to mitigate the retrieval costs or the need to retrieve IVCFs may reduce the overall cost burden of IVCFs.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Rabih Chaer
- UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania
| |
Collapse
|
3
|
Stevens H, Bortz H, Chao S, Ramanan R, Clements W, Peter K, McFadyen JD, Tran H. Improving the rate of inferior vena cava filter retrieval through multidisciplinary engagement. Res Pract Thromb Haemost 2023; 7:100040. [PMID: 36852111 PMCID: PMC9958400 DOI: 10.1016/j.rpth.2023.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 01/09/2023] Open
Abstract
Background The placement of retrievable inferior vena cava (IVC) filters occurs commonly, but retrieval rates remain low. Consequently, there is an unmet clinical need to ensure appropriate follow-up and retrieval of these devices. Objectives To determine the association between an IVC filter surveillance team with filter retrievals or a documented filter plan, time to retrieval, and incidence of filter complications or recurrent venous thromboembolism. Methods Ambidirectional cohort study evaluating consecutive IVC filter insertions before and after the implementation of a multidisciplinary surveillance team (MDST). We report an odds ratio (OR) with 95% CIs, adjusted by age, sex, weight, and malignancy status. Results Overall, 453 patients were included, with 272 individuals in the pre-MDST cohort and 181 individuals in the post-MDST cohort. The MDST was associated with a higher composite primary outcome of IVC filter retrieval or a documented filter plan from 79.4% in the pre-MDST cohort to 96.1% in the post-MDST cohort (OR, 6.44; 95% CI, 3.06-15.84). Compared with the pre-MDST cohort, IVC filter retrieval rates were higher in the post-MDST cohort (52.6%-73.5%, respectively; (OR, 2.50; 95% CI, 1.67-3.78). The MDST was associated with a shorter median time-to-filter retrieval (187-150 days, hazard ratio, 1.78; 95% CI, 1.39-2.29), but there was no significant difference when comparing symptomatic or clinically significant IVC filter complications, recurrent venous thromboembolism, or mortality. Conclusion Our study demonstrates the importance of a structured program to ensure timely IVC filter retrieval and ultimately improve patient care.
Collapse
Affiliation(s)
- Hannah Stevens
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia,Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia,Correspondence Hannah Stevens, Department of Clinical Haematology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia. @hannahpstevens
| | - Hadley Bortz
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Sharon Chao
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Radha Ramanan
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Australia,Department of Surgery, Monash University Central Clinical School, Melbourne, Australia,National Trauma Research Institute, Melbourne, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia,Department of Cardiology, Alfred Hospital, Melbourne, Melbourne, Australia,Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria, Australia
| | - James D. McFadyen
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia,Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia,Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria, Australia
| | - Huyen Tran
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Roberts LN, Ammar T, Czuprynska J, Arya R, Wilkins CJ. Automated Inferior Vena Cava Filter Retrieval Requests and Hematology Liaison Improves Retrieval and Reduces the Use of Temporary Inferior Vena Cava Filters. TH OPEN 2020; 4:e116-e118. [PMID: 32548567 PMCID: PMC7293543 DOI: 10.1055/s-0040-1713176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lara N Roberts
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Thoraya Ammar
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Julia Czuprynska
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Roopen Arya
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - C Jason Wilkins
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
5
|
Robbins JM, Garwe T, McCarthy CK, Sarwar Z, Gonzalez RA, Zander TL, Jalla AN, Conner KS, Stewart KE, Albrecht RM. Removal of retrievable inferior vena cava filters before discharge: Is it associated with increased incidence of pulmonary embolism? J Trauma Acute Care Surg 2019; 87:1113-1118. [PMID: 31166290 DOI: 10.1097/ta.0000000000002395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severely injured trauma patients are at high risk of developing deep venous thrombosis and pulmonary emboli (PE), and may have contraindications to prophylactic or therapeutic anticoagulation. Retrievable inferior vena cava filters (rIVCFs) are used to act as a mechanical obstruction to prevent PE in high risk populations and those with deep venous thrombosis who cannot be anticoagulated. The removal rate of rIVCFs is variable in trauma centers, including our previous published rate of 50% to 89%/year. Indwelling filters carry a risk of significant morbidity and the success of retrieval decreases as the dwell time increases. We hypothesized that once patients could receive appropriate prophylactic or therapeutic anticoagulation, rIVCF could be removed before hospital discharge without impact on occurrence or recurrence of PE. METHODS All trauma patients with rIVCF placed and removed between January 2006 and August 2018 were reviewed. We collected data from record review from admission to 6 months postfilter removal, including demographics, filter indication, filter type, dwell time, placement and removal complications, antithrombosis medications, location of venous thromboembolism, complications, and discharge disposition. Exposure of interest was timing of filter removal: before (BEF) or after hospital discharge (AFT). The outcome of interest was whether the patient had a documented PE within 6 months of filter removal. RESULTS A total of 281 rIVCFs were placed, 218 were eligible for removal, 72.4% (158/218) were retrieved with 63% (100/158) removed before discharge. Mean filter duration was 26 days and 103 days for the before and after groups, respectively. No differences (p > 0.05) were noted in the distribution of demographic and clinical factors except for filter indication (venous thromboembolism indication, 95% in AFT vs. 74% in BEF, p = 0.0043). Postremoval PE rates were 0% BEF and 1% AFT (Fisher's exact test, p = 1.000). CONCLUSION Our results suggest that removal of rIVCFs before discharge once patients are appropriately anticoagulated is a safe strategy to improve retrieval rates. LEVEL OF EVIDENCE Therapeutic, level V.
Collapse
Affiliation(s)
- Justin M Robbins
- From the College of Medicine (J.M.R., R.A.G., T.Z.), Department of Surgery (T.G., C.K.M., Z.S., A.N.J., K.S., R.M.A.), Department of Biostatistics and Epidemiology (T.G.), and Department of Radiology (K.S.C.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Sentry Bioconvertible Inferior Vena Cava Filter: Study of Stages of Incorporation in an Experimental Ovine Model. Int J Vasc Med 2018; 2018:6981505. [PMID: 30112213 PMCID: PMC6077616 DOI: 10.1155/2018/6981505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022] Open
Abstract
The Sentry inferior vena cava (IVC) filter is designed to provide temporary protection from pulmonary embolism (PE) and then bioconvert to become incorporated in the vessel wall, leaving a patent IVC lumen. Objective. To evaluate the performance and stages of incorporation of the Sentry IVC filter in an ovine model. Methods. Twenty-four bioconvertible devices and 1 control retrievable filter were implanted in the infrarenal IVC of 25 sheep, with extensive daily monitoring and intensive imaging. Vessels and devices were analyzed at early (≤98 days, n = 10) and late (180 ± 30 days, n = 14 study devices, 1 control) termination and necropsy time-points. Results. Deployment success was 100% with all devices confirmed in filtering configuration, there were no filter-related complications, and bioconversion was 100% at termination with vessels widely patent. By 98 days for all early-incorporation analysis animals, the stabilizing cylindrical part of the Sentry frame was incorporated in the vessel wall, and the filter arms were retracted. By 180 days for all late-incorporation analysis animals, the filter arms as well as frames were stably incorporated. Conclusions. Through 180 days, there were no filter-related complications, and the study devices were all bioconverted and stably incorporated, leaving all IVCs patent.
Collapse
|
7
|
Stern JR, Cafasso DE, Meltzer AJ, Schneider DB, Ellozy SH, Connolly PH. Prophylactic Inferior Vena Cava Filter Utilization and Risk Factors for Nonretrieval. Vasc Endovascular Surg 2017; 52:34-38. [PMID: 29121841 DOI: 10.1177/1538574417740507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Inferior vena cava filters (IVCFs) are often placed for prophylactic indications. We sought to better define the range of practice indications for placement of prophylactic IVCFs, as well as the specific retrieval rate and risk factors for nonretrieval. METHODS A retrospective, single-institution review of patients undergoing IVCF placement over a 2-year period was performed. Patients undergoing prophylactic IVCF placement were selected from a prospectively collected database. Risk factors for nonretrieval were identified using a multivariate logistic regression model. RESULTS Of 615 IVCFs placed, 256 were retrievable filters placed for prophylactic indications and comprised the study cohort. The most common indications were a history of venous thromboembolic disease (43.7%), malignancy (35.1%), bleeding risk precluding anticoagulation (33.9%), and trauma (22.6%). One hundred sixty-three (63.6%) were placed preoperatively. Placement was performed in 70.3% by interventional radiology, 21.4% by vascular surgery, and 8.2% by cardiology. The most common requesting services were orthopedics (67%), general surgery (11%), neurosurgery (9%), and bariatric surgery (7%). Of all, 67.6% were placed in the inpatient setting and 32.4% in outpatients. Seventy-one (27.7%) of the 256 prophylactic filters were retrieved, with a mean indwelling time of 92 ± 74 days. Inpatients were significantly less likely to have their IVCF removed (32.4% vs 57.8%; P < .001), as were preoperative patients. CONCLUSIONS This study helps define current practice trends for the placement of prophylactic IVCFs. Importantly, the specific retrieval rate for prophylactic filters is low. This suggests that prophylactic IVCF usage is suboptimal and efforts should be taken to increase retrieval, especially among inpatients and perioperative patients.
Collapse
Affiliation(s)
- Jordan R Stern
- 1 Division of Vascular & Endovascular Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Danielle E Cafasso
- 1 Division of Vascular & Endovascular Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Andrew J Meltzer
- 1 Division of Vascular & Endovascular Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Darren B Schneider
- 1 Division of Vascular & Endovascular Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Sharif H Ellozy
- 1 Division of Vascular & Endovascular Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Peter H Connolly
- 1 Division of Vascular & Endovascular Surgery, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
8
|
Urias D, Silvis J, Mesropyan L, Oberlander E, Simunich T, Tretter J. Retrievable inferior vena cava filters in geriatric trauma: Is there an age bias? Injury 2017; 48:148-152. [PMID: 27503315 DOI: 10.1016/j.injury.2016.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/02/2016] [Accepted: 07/04/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trauma patients are at increased risk for developing venous thromboembolic (VTE) disease. The EAST (Eastern Association for the Surgery of Trauma) practice management guidelines identified risk factors for VTE, as well as indications for prophylactic inferior vena cava filters (IVCF). In a 2009 study, our institution found a 26% retrieval rate for IVCF. Lack of retrieval was most consistently due to lack of follow-up. Our study is a follow-up analysis for retrieval rate of IVCF, since the formation of a geriatric trauma service. We anticipated that geriatric trauma patients would have a lower rate of IVCF retrieval compared to the general trauma patient. METHODS Our study population consisted of trauma patients admitted from January 2008 to August 2013, with documented VTE or high risk for VTE with contraindication to anticoagulation. INCLUSION CRITERIA IVCF placed in trauma patients. EXCLUSION CRITERIA permanent filters, retrievable filters placed permanently, non-trauma patients, superior vena cava filters and patients who died before discharge. RESULTS During the study period, 160 trauma patients had an IVCF placed, of which 147 survived and were discharged. Of those patients, 66% (97/147) were planned for retrieval. Overall, the retrieval rate was 34% (33/97). Following age categorization, rates were 47% (30/64) and 9% (3/33) for those <65 and >/=65 years old, respectively. Applying Fisher's Exact Test to a crosstab of planned retrieval by age category yielded a statistically significant difference, p<0.0005 at alpha=0.05. In the geriatric population with IVCFs not retrieved, 23% (7/30) died and 67% (20/30) were lost to follow-up. CONCLUSION IVCF plays a critical role in the management of trauma patients with VTE, particularly the geriatric population. Since our 2009 study, we have improved nearly ten percentage points (26% to 34%); however, we exposed an age bias with retrieval rate being lower in patients >/=65 compared to those <65 (9% vs. 47%).
Collapse
Affiliation(s)
- Daniel Urias
- General Surgery Resident Conemaugh Memorial Medical Center, Johnstown, PA, United States.
| | - Jennifer Silvis
- General Surgery Resident Conemaugh Memorial Medical Center, Johnstown, PA, United States.
| | - Lusine Mesropyan
- General Surgery Resident Conemaugh Memorial Medical Center, Johnstown, PA, United States.
| | - Emma Oberlander
- General Surgery Resident Conemaugh Memorial Medical Center, Johnstown, PA, United States.
| | - Thomas Simunich
- Research Associate Conemaugh Memorial Medical Center, Johnstown, PA, United States.
| | - James Tretter
- Vascular Surgeon Valley Health Winchester, VA, United States.
| |
Collapse
|
9
|
Winters JP, Morris CS, Holmes CE, Lewis P, Bhave AD, Najarian KE, Shields JT, Charash W, Cushman M. A multidisciplinary quality improvement program increases the inferior vena cava filter retrieval rate. Vasc Med 2016; 22:51-56. [DOI: 10.1177/1358863x16676658] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Published reports indicate low retrieval rates for retrievable inferior vena cava (IVC) filters. We performed a historic-controlled study of a 5-year intervention (March 2007 to February 2012) to improve IVC filter retrieval rates at a university medical center serving a rural area. All adults with a retrievable filter placed were included, except those with a life expectancy <6 months. The intervention included initial verbal counseling and printed educational materials, correspondence after discharge, and a hematology consultation. The control group included patients with retrievable filters placed in the 15 months preceding study initiation. In the control group, 116 filters were placed and 27 (23%) were removed, compared to 378 filters placed and 169 (45%) removed during the intervention. Adjusting for patient characteristics, the odds ratio of retrieval during the intervention was 3.03 (95% CI 1.85–4.27) compared to the control period. An intervention including patient education and hematology follow-up appeared to significantly improve IVC filter retrieval rates.
Collapse
Affiliation(s)
- John P Winters
- Thrombosis and Hemostasis Program, Division of Hematology – Oncology, Department of Medicine, and Cardiovascular Research Institute of Vermont, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Christopher S Morris
- Department of Radiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Chris E Holmes
- Thrombosis and Hemostasis Program, Division of Hematology – Oncology, Department of Medicine, and Cardiovascular Research Institute of Vermont, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Patricia Lewis
- Thrombosis and Hemostasis Program, Division of Hematology – Oncology, Department of Medicine, and Cardiovascular Research Institute of Vermont, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Anant D Bhave
- Department of Radiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Kenneth E Najarian
- Department of Radiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Joseph T Shields
- Department of Radiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - William Charash
- Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Mary Cushman
- Thrombosis and Hemostasis Program, Division of Hematology – Oncology, Department of Medicine, and Cardiovascular Research Institute of Vermont, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| |
Collapse
|
10
|
Out of Sight, out of Mind? An Audit Which Proposes a Follow-Up and Management Pathway for Inferior Vena Cava Filters. THROMBOSIS 2016; 2016:6538456. [PMID: 27110399 PMCID: PMC4826707 DOI: 10.1155/2016/6538456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/20/2016] [Accepted: 02/01/2016] [Indexed: 12/04/2022]
Abstract
Insertion of an IVC filter can be a safe and effective way to avoid PE in thrombosis patients who cannot be anticoagulated. If temporary filters are not promptly removed they can become difficult to remove, causing avoidable complications and often requiring lifelong warfarin. In this study, two sequential audits of retrieval of temporary IVC filters were conducted before and after the implementation of a coordinated management strategy for IVC filter follow-up. 33 filter placements were examined over a 15-month period (Group A). Following implementation of the strategy a comparable 15-month period in which 33 IVC filters were placed was audited (Group B). Following implementation, failed retrievals dropped from 15% to 9%. The number successfully retrieved did not change at 45%. The number made permanent from the outset following expert discussion increased from 12% to 39%. The number of filters with no attempted retrieval and no consultation about retrieval decreased from 27% to 9% (these patients were lost to follow-up with multiple contact attempts made). In Group B 100% of placed IVC filters were followed up appropriately. The proposed model is an easily implemented plan to avoid patient morbidity caused by temporary IVC filters made unintentionally permanent by loss to follow-up.
Collapse
|
11
|
Inagaki E, Farber A, Eslami MH, Siracuse JJ, Rybin DV, Sarosiek S, Sloan JM, Kalish J. Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach. J Vasc Surg Venous Lymphat Disord 2016; 4:276-82. [PMID: 27318045 DOI: 10.1016/j.jvsv.2015.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The option to retrieve inferior vena cava (IVC) filters has resulted in an increase in the utilization of these devices as stopgap measures in patients with relative contraindications to anticoagulation. These retrievable IVC filters, however, are often not retrieved and become permanent. Recent data from our institution confirmed a historically low retrieval rate. Therefore, we hypothesized that the implementation of a new IVC filter retrieval protocol would increase the retrieval rate of appropriate IVC filters at our institution. METHODS All consecutive patients who underwent an IVC filter placement at our institution between September 2003 and July 2012 were retrospectively reviewed. In August 2012, a multidisciplinary task force was established, and a new IVC filter retrieval protocol was implemented. Prospective data were collected using a centralized interdepartmental IVC filter registry for all consecutive patients who underwent an IVC filter placement between August 2012 and September 2014. Patients were chronologically categorized into preimplementation (PRE) and postimplementation (POST) groups. Comparisons of outcome measures, including the retrieval rate of IVC filters along with rates of retrieval attempt and technical failure, were made between the two groups. RESULTS In the PRE and POST groups, a total of 720 and 74 retrievable IVC filters were implanted, respectively. In the POST group, 40 of 74 filters (54%) were successfully retrieved compared with 82 of 720 filters (11%) in the PRE group (P < .001). Furthermore, a greater number of IVC filter retrievals were attempted in the POST group than in the PRE group (66% vs 14%; P < .001). No significant difference was observed between the PRE and POST groups for technical failure (17% vs 18%; P = .9). CONCLUSIONS The retrieval rate of retrievable IVC filters at our institution was significantly increased with the implementation of a new IVC filter retrieval protocol with a multidisciplinary team approach. This improved retrieval rate is possible with minimal dedication of resources and can potentially lead to a decrease in IVC filter-related complications in the future.
Collapse
Affiliation(s)
- Elica Inagaki
- Department of Surgery, Boston Medical Center, Boston, Mass
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, Mass
| | - Mohammad H Eslami
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, Mass
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, Mass
| | - Denis V Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - Shayna Sarosiek
- Section of Hematology and Oncology, Department of Medicine, Boston University and Boston Medical Center, Boston, Mass
| | - J Mark Sloan
- Section of Hematology and Oncology, Department of Medicine, Boston University and Boston Medical Center, Boston, Mass
| | - Jeffrey Kalish
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, Mass.
| |
Collapse
|
12
|
Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.: Consortium for Spinal Cord Medicine. Top Spinal Cord Inj Rehabil 2016; 22:209-240. [PMID: 29339863 PMCID: PMC4981016 DOI: 10.1310/sci2203-209] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
13
|
Leeper WR, Murphy PB, Vogt KN, Leeper TJ, Kribs SW, Gray DK, Parry NG. Are retrievable vena cava filters placed in trauma patients really retrievable? Eur J Trauma Emerg Surg 2015. [PMID: 26201391 DOI: 10.1007/s00068-015-0553-5] [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: 10/23/2022]
Abstract
PURPOSE Concerns have arisen regarding the use of retrievable inferior vena cava filters (rIVCFs) in trauma patients due to increasing reports of low retrieval rates. We hypothesized that complete follow-up with a dedicated trauma nurse practitioner would be associated with a higher rate of retrievability. This study was undertaken to determine the rate of retrievability of rIVCFs placed in a Canadian Lead Trauma Centre, and to compare the rate of retrievability in our trauma population to our non-trauma patients. METHODS We performed a retrospective cohort study of all patients with rIVCF placed between Jan 1 2000 and June 30 2014. Data were collected on demographics, indication for filter placement, retrieval status, and reasons for non-retrieval. Comparison was made between trauma patients and non-trauma patients. RESULTS A total of 374 rIVCFs were placed (61 in trauma patients and 313 in non-trauma patients) and follow-up was complete for the entire cohort. Filter retrieval was achieved in 86.9 % of trauma patients. Reasons for non-retrieval were technical in two patients, and death before retrieval in six patients. Retrieval was successful in 48.9 % of non-trauma patients. CONCLUSIONS This study demonstrates that rIVCFs can be successfully retrieved amongst trauma patients. We demonstrated a higher rate of successful retrieval amongst trauma patients than non-trauma patients in our institution. Careful patient follow-up may play a role in successful retrieval of rIVCFs.
Collapse
Affiliation(s)
- W R Leeper
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada. .,Division of Critical Care, London Health Sciences Centre, London, ON, Canada.
| | - P B Murphy
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Division of General Surgery, London Health Sciences Centre, Room E2-217, Victoria Hospital, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - K N Vogt
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - T J Leeper
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - S W Kribs
- Department of Radiology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - D K Gray
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Trauma Program, London Health Sciences Centre, London, ON, Canada
| | - N G Parry
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Trauma Program, London Health Sciences Centre, London, ON, Canada.,Centre for Critical Illness Research, London, ON, Canada.,Division of Critical Care, London Health Sciences Centre, London, ON, Canada
| |
Collapse
|
14
|
Avery A, Stephens M, Redmond K, Harper J. Initial experience using the rigid forceps technique to remove wall-embedded IVC filters. J Med Imaging Radiat Oncol 2015; 59:306-11. [DOI: 10.1111/1754-9485.12299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 02/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Allan Avery
- Department of Medical Imaging; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Maximilian Stephens
- Department of Medical Imaging; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Kendal Redmond
- Department of Medical Imaging; Princess Alexandra Hospital; Brisbane Queensland Australia
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - John Harper
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- Department of Medical Imaging; Princess Alexandra Hospital; Brisbane Queensland Australia
| |
Collapse
|
15
|
Charlton-Ouw KM, Leake SS, Sola CN, Sandhu HK, Albarado R, Holcomb JB, Miller CC, Safi HJ, Azizzadeh A. Technical and Financial Feasibility of an Inferior Vena Cava Filter Retrieval Program at a Level One Trauma Center. Ann Vasc Surg 2015; 29:84-9. [DOI: 10.1016/j.avsg.2014.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/02/2014] [Accepted: 05/18/2014] [Indexed: 11/28/2022]
|
16
|
Thornburg K, Obmann M, Batool A, Nikam S, Mariner D. Percutaneous retrieval of an inferior vena cava filter causing right ureter obstruction. Ann Vasc Surg 2013; 28:122.e11-3. [PMID: 24332261 DOI: 10.1016/j.avsg.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/09/2013] [Accepted: 09/02/2013] [Indexed: 10/26/2022]
Abstract
Retrievable inferior vena cava filters (IVCFs) are known to provide safe and effective pulmonary embolism protection when used appropriately. Long-term complications have been reported over the past 10 years, including vena cava perforation, filter migration, strut fracture, and injury to adjacent structures. This article describes the case of a 44-year-old woman who presented with right ureteral obstruction from strut impingement by a Bard Recovery IVCF (Tempe, AZ, USA). The filter had been in place for 6 years, and the authors were successful in retrieving it using a percutaneous endovascular approach, despite an unexpected chronic right innominate vein occlusion. In addition to highlighting the technical feasibility of long-term retrieval, this case underscores the importance of an IVCF registry to improve retrieval rates. This close monitoring and timely retrieval of filters may help prevent serious long-term complications.
Collapse
Affiliation(s)
- Kristina Thornburg
- Department of Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA.
| | - Melissa Obmann
- Department of Endovascular and Vascular Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA
| | - Amber Batool
- Department of Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA
| | - Shivprasad Nikam
- Department of Endovascular and Vascular Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA
| | - David Mariner
- Department of Endovascular and Vascular Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA
| |
Collapse
|
17
|
|
18
|
Swami U, Annunziata G, Fulger I. Experience with vena cava filters at a large community hospital and level-I trauma center: indications, complications, and compliance barriers. Clin Appl Thromb Hemost 2013; 20:546-52. [PMID: 24085746 DOI: 10.1177/1076029613505766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Inferior vena cava filters (IVCF) are used liberally in clinical practice and have been associated with multiple complications. Herein, we present results from our institution. METHODS Records of consecutive patients discharged between January 1, 2009 and 2012 were reviewed. Indications were subcategorized under absolute, relative, and prophylactic. Student t test and Kaplan-Meier survival analysis were employed. RESULTS During this period, 254 vena cava filters (VCF) were placed. Of these, 65 were placed for absolute indication, 28 for relative, and 161 for prophylaxis. Follow-up imaging was available for 96 patients of which 15 showed complications. Successful retrieval of 19 filters was achieved. CONCLUSION The study demonstrates that most IVCF are being placed for prophylaxis with low retrieval rate. This contradicts current recommendations. Moreover frequent migration and penetration of IVCF can lead to serious complications. Strict enforcement of IVCF placement guidelines and setting up of filter clinics for timely retrieval is suggested.
Collapse
Affiliation(s)
- Umang Swami
- Department of Internal Medicine, St Barnabas Hospital, Bronx, NY, USA
| | | | - Ilmana Fulger
- Department of Hematology and Oncology, St Barnabas Hospital, Bronx, NY, USA
| |
Collapse
|
19
|
Rajasekhar A, Streiff MB. Vena cava filters for management of venous thromboembolism: A clinical review. Blood Rev 2013; 27:225-41. [DOI: 10.1016/j.blre.2013.07.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
20
|
Ni H, Win LL. Retrievable inferior vena cava filters for venous thromboembolism. ISRN RADIOLOGY 2013; 2013:959452. [PMID: 24967292 PMCID: PMC4045516 DOI: 10.5402/2013/959452] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/25/2013] [Indexed: 11/23/2022]
Abstract
Inferior vena cava (IVC) filters are used as an alternative to anticoagulants for prevention of fatal pulmonary embolism (PE) in venous thromboembolic disorders. Retrievable IVC filters have become an increasingly attractive option due to the long-term risks of permanent filter placement. These devices are shown to be technically feasible in insertion and retrieval percutaneously while providing protection from PE. Nevertheless, there are complications and failed retrievals with these retrievable filters. The aim of the paper is to review the retrievable filters and their efficacy, safety, and retrievability.
Collapse
Affiliation(s)
- Han Ni
- Internal Medicine, Faculty of Medicine, SEGi University, No. 9 Jalan Teknologi, Taman Sains Selangor, Kota Damansara, PJU 5, 47810 Petaling Jaya, Selangor, Malaysia
| | - Lei Lei Win
- Paediatrics, Faculty of Medicine, SEGi University, No. 9 Jalan Teknologi, Taman Sains Selangor, Kota Damansara, PJU 5, 47810 Petaling Jaya, Selangor, Malaysia
| |
Collapse
|