Fracture Rate and Serious Complications of Vena Cava Filters

Abstract

Purpose: To retrospectively evaluate the prevalence of fracture and fragment embolization of inferior vena cava (IVC) filters. Methods: Electronic medical records and imaging studies of all Kaiser Permanente patients who received IVC filters from August 2000 until August 2010 were retrospectively reviewed for filter complications. Results: 283 patients received an IVC filter during the study period. 143 patients were deceased, while 140 are living. Among deceased patients, the average age at the time of death was 69.8 ± 15.3 [range: 24.7 -99.2] years; 55.9% were men; the mean implantation-to-image time was 13.6 ± 20.6 [range: 0 -92.4] months, and there were no reported major complications attributable to filter migration or fracture at a mean of 16.8 ± 24.8 [range: 0 -119.6] months following implantation. One of 14 (7.1%) G2 filters perforated the aorta, which already had a stent graft in place. Among those patients still living, the average age was 67.3 ± 15.2 [range: 15.2 -97.3] years, 47.1% were men, the mean implantation-to-image time was 33.3 ± 36.5 [range: 0.1-141.7] months, and there were no reported major complications at a mean of 35.3 ± 36.5 [range: 0 -141.7] months following implantation. Three of 60 (5.0%) Trapease filters were found to have at least 1 strut fracture. There were no cases of filter migration or fragment embolization. The overall fracture rate of all filters with an implantation-to-image-time greater than two years (mean implantation-to-image time 4.7 ± 2.7 [range: 2.0 -11.8] years) was 3 of 67 (4.5%). Bard G2 and G2X filters had a 0% fracture and embolization rate at a mean of 19.0 ± 16.6 [range: 0.07 -49.5] months after implantation. Conclusions: IVC filters, regardless of type, have a low prevalence of fracture and we found no cases of fragment embolization.

Inferior vena cava filter fracture and migration to the pulmonary artery

“…reported a relatively low incidence of fracture with TrapEase filter (3.8%). [3] According to Ziegler et al., the incidence of filter fracture in OptEase filter was lower than that in other filters (2.0%, 3 of 150 patients). [4] Despite its rare occurrences, fractured filter fragment can reach anywhere in the body along the venous flow, it could have fatal results, especially in heart and pulmonary artery.…”

“…Cases of fracture and embolization of IVC filter strut leading to right ventricle perforation and cardiac tamponade were reported. [3 , 5] Therefore, early detection of filter complication is important to prevent possible fatal situation that may arise.…”