Extensive Thrombotic Complications After Inferior Vena Cava Filter Placement in 2 Adolescents With Spinal Cord Injury

Abstract

We report extensive thrombotic complications of inferior vena cava (IVC) filters that were placed for primary prophylaxis in 2 pediatric trauma patients with spinal cord injuries. Although thrombosis is a known common complication in adults with IVC filters, we were unable to find any reports in the literature of this complication in children. These cases highlight a significant problem with the use of prophylactic IVC filters that are not subsequently retrieved, particularly in young trauma patients with decades to live. The overall reported complications of IVC filters in the pediatric literature are also reviewed.

Inferior vena cava (IVC) filters in children: A 10‐year single center experience

“…Other recognized complications include IVC penetration, filter infection, dislocation, migration, and rupture of the IVC . Our complication rate is similar to the cumulative incidence of the IVC filter‐related complications in children in the available literature with a rate of 16.9% (20/118) . In view of the potential high risk for long‐term complications, the extensive utilization of IVC filter in children should be reconsidered, especially when placed for prophylactic indications where there is no evidence to support their use.…”

“…The overall use of IVC filters in adults has increased dramatically in recent years as an alternative to anticoagulation therapy in the management of VTE . In children, data regarding IVC filter placement are insufficient and based on small case series and multiple case reports . The potential for growth and extended longevity in the pediatric age group may expose these individuals to a greater risk for filter‐related complications.…”

“…The ISS is defined as the sum of the squares in each of the three most severely injured areas. [26] ISS was categorized as mild (<9), moderate (9)(10)(11)(12)(13)(14)(15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and profound (>25). [27] Institutional review board approval waiving informed consent was obtained for this study.…”

“…Management recommendations for VTE in children are largely extrapolated from treatment guidelines in adults with no further validation . Experience with IVC filters in children is limited to a few case series and scattered case reports …”

“…[7] Experience with IVC filters in children is limited to a few case series and scattered case reports. [6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In adults, long-term complications of IVC filters are well described in the literature. [24] Considering the long potential lifespan of pediatric patients, these risks coupled with the low retrieval rates reported in adult patients raise major concerns regarding their utilization in children.…”