Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach

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.

Phlegmasia cerulea dolens: a rare cause of shock

“…Complications associated with permanent IVC filters, including IVC thrombosis, spurred the development of retrievable IVC filters in the 1990s but these devices were not approved in the United States until 2004 . Thus, the IVC filter in our patient was unlikely to have been designed for retrieval.…”

“…Thus, the IVC filter in our patient was unlikely to have been designed for retrieval. Interestingly, a recent study found that despite a 200% increase the use of these “temporary” IVC filters, the actual retrieval rates remain quite low (12%–45%) .…”

“…IVC filters, the actual retrieval rates remain quite low (12%-45%) [5]. Beyond malignancy and thrombophilia, the risk factors for IVC filter thrombosis remain poorly defined.…”

An Informatics Approach to Facilitate Clinical Management of Patients With Retrievable Inferior Vena Cava Filters

“…In three studies, Klinken et al [5], Inagaki et al [6], and Lynch [7] describe prospectively tracking patients who received IVC filters in a database. In all of these studies, an IR team assumed responsibility for follow-up of patients, and Inagaki et al described the creation of a multidisciplinary task force.…”

Institutional protocols can improve IVC filter retrieval rates

“…13 Several studies demonstrated the effectiveness of multidisciplinary filter retrieval protocols, which utilize the input of a number of different specialists to provide care. [1][2][3][4] One such study found that IVC filter retrieval tripled over the course of five years after implementation of post-procedure care and patient education, maintenance of an IVC filter database, post-discharge patient outreach, and intervention by a thrombosis specialist to assess the ongoing need for the filter and to coordinate retrieval.4 Similarly, other academic medical centers independently enacted multidisciplinary approaches that improved their retrieval rates by augmenting patient education, standardizing post-procedure care, and designating coordinators for post-procedure follow-up and filter retrieval. 1,3,10 The University of Pittsburgh Medical Center utilized a multidisciplinary approach that emphasized educating trauma providers, rather than patients, on the indications for retrievable IVC filter insertion and retrieval.…”