Inferior Vena Cava Filters: Indications, Outcomes, and Evidence

Abstract

Filter technology seems relatively stable, although absorbable devices are an area of investigational interest. The indications for filter placement remain controversial, with wide variations in adherence to guidelines, and relatively poor quality of data about the specific prophylactic indications of trauma or bariatric surgery. The outcomes of filters are not well-defined despite widespread clinical use, and good data remains difficult to obtain. Several larger database and institutional retrospective studies support the notions that while filters prevent pulmonary embolism, they may be associated with venous thrombotic complications. Some subsets of cancer patients may be at increased risk of these complications, but whether the filter or the underlying hypercoagulable state is the cause is not clear. Lastly, although the benefits of filter retrieval are widely assumed (but not proven), filter retrieval rates remain lower than expected. The single most influential factor in improving filter retrieval rates is dedicated follow-up with intent to retrieve the filter.

Sentry Bioconvertible Inferior Vena Cava Filter: Study of Stages of Incorporation in an Experimental Ovine Model

“…The established primary treatment for venous thromboembolic (VTE) disease including PE and DVT is pharmacologic management with anticoagulant agents. However, in many patients anticoagulation is contraindicated during periods of high PE risk, and inferior vena cava (IVC) filters are recommended for these situations [ 3 , 7 – 9 ].…”

“…In practice, however, these filters have not been routinely retrieved, and while remaining indwelling, they have been associated with a time-dependent increase in retrievable-filter-specific complications including device tilting, fracture, migration, embolization, thrombosis, IVC perforation, surgery, and death [ 4 , 11 – 15 ]. In April 2010, the US Food and Drug Administration (FDA) issued a safety communication (which was updated in May 2014) recommending that physicians “consider removing the filters as soon as protection from pulmonary embolism is no longer needed” [ 9 , 16 , 17 ]. According to a subsequently published FDA decision analysis, the benefit/risk profile begins to favor filter removal between 29 and 54 days after device implantation [ 16 ].…”

Massive hemoptysis in a patient with pulmonary embolism, a real therapeutic conundrum

“…However, anticoagulation is contraindicated in patients with severe hemoptysis since it might lead to fatal haemorrhage in the airways. Retrievable IVC filter insertion in acute PE should be performed if anticoagulation is contraindicated [8] as in the case of our patient. Non-permanent filters are preferred to be used in cases where VTE is related to a transient risk factor [8].…”

“…Retrievable IVC filter insertion in acute PE should be performed if anticoagulation is contraindicated [8] as in the case of our patient. Non-permanent filters are preferred to be used in cases where VTE is related to a transient risk factor [8]. The IVC filter protects from PE recurrence but should be removed when the anticoagulation can be re-administered since unretrieved removable IVC filters may carry significant long-term risks [9].…”

One-Year Analysis of the Prospective Multicenter SENTRY Clinical Trial: Safety and Effectiveness of the Novate Sentry Bioconvertible Inferior Vena Cava Filter

“…Although the majority of retrievable IVC filters are placed to provide short-term protection against PE after index events including surgery, trauma, and hospitalization, rates of retrieval vary widely between centers and are often as low as 20%-35% (20,21), despite the 2010 FDA safety communication about the potential for long-term complications, which was updated in 2014 (4,7,16,27,32). The factors that have been noted as responsible for retrievable filters being left in place for long periods or permanently include technical failure during retrieval attempts, endothelialization, and lack of patient compliance (4,11,14,22). Whereas the rate of filter retrieval may not have increased appreciably since the FDA advisory, a recent study has documented a 29.0% decrease in IVC filter placement from 2010 to 2014 while the rate of hospitalizations related to VTE remained steady (33).…”