Effectiveness of Inferior Vena Cava Filters without Anticoagulation Therapy for Prophylaxis of Recurrent Pulmonary Embolism

Inferior vena cava filters: a framework for evidence-based use

Venous thromboembolism (VTE) is a common cause of morbidity and mortality. Although most patients can be managed safely with anticoagulation, inferior vena cava filters (IVCFs) represent an important alternative to anticoagulation in a small subset of patients. IVCF use has expanded exponentially with the advent of retrievable filters. Indications for IVCFs have liberalized despite limited evidence supporting this practice. Because indiscriminate use of IVCFs can be associated with net patient harm, knowledge of the risks and benefits of these devices is essential to optimal evidence-based practice. Patients with acute VTE and absolute contraindications to anticoagulation or major complications from anticoagulation are universally agreed indications for IVCFs. However, the reliance on IVCFs for primary VTE prophylaxis in high-risk patients is not substantiated by the available literature. This review examines trends in IVCF use, practice-based recommendations on IVCF use in various clinical scenarios, complications associated with indwelling IVCFs, and indications for IVCF retrieval.

Acute Thrombotic Complication Post-Endovenous Ablation With Mobile Thrombus: A Case Study

Endovenous ablation is a common procedure performed on the superficial veins of the lower extremities to treat symptoms of venous insufficiency and varicose veins. While endovenous ablation is a minimally invasive procedure, patients may develop thrombotic complications including endovenous heat-induced thrombosis. Endovenous heat-induced thrombosis is a rare complication of thrombus extension from the superficial vein into or near the deep system postprocedure. In this case report, a female with a history of recent endovenous ablation presented to the emergency department with symptoms of a pulmonary embolism. Sonographic evaluation of the right lower extremity revealed extension of thrombus from the ablated superficial vein into the common femoral vein. Thrombus was also noted in the left lower extremity extending from the ablated superficial vein to approximately the saphenofemoral junction. While the left lower extremity was being interrogated, the thrombus was documented, via a cine clip, liberating from the occluded great saphenous vein. Further assessment utilizing computed tomography revealed bilateral pulmonary emboli. This unique case emphasizes the importance of sonographic evaluation post-endovenous ablation.