Inferior Vena Cava Filters

Abstract

Inferior vena cava filters appear to be effective in preventing recurrent pulmonary embolism. Despite the large published experience with IVC filters, many questions remain about their indications, safety, and effectiveness. Anticoagulant therapy, if not contraindicated, should be used in conjunction with filters. While there is no ideal filter, some situations call for specific filters. Filter selection and insertion require experience, modern angiographic technique, and collaboration between clinicians caring for patients and the interventional radiologists or surgeons inserting the device.

New Bases for Percutaneous Caval Filter Placement on Site in Geriatric Institution in Patients Aged 75 and Older

“…Weak adherence to ACT meets consensus for PCFP indications 6 . As in other studies, the average complication rate of our series was close to 5%, and the first prognostic survival factor was the initial clinical status of the patient 7,8 . The 1‐year survival rate was low in our study, but the average age of our patients was 87.0, versus 64.5 in other studies.…”

Anticoagulation or Inferior Vena Cava Filter Placement for Patients With Primary Intracerebral Hemorrhage Developing Venous Thromboembolism?

“…50 The principal indication for placement is a strict contraindication to or failure of anticoagulant therapy. 51 The only randomized trial of filters was performed by Decousus et al, 2 who randomized 400 patients with symptomatic PDVT with or without concomitant symptomatic PE considered to be at high risk of incident or recurrent PE to treatment with anticoagulants alone or in combination with IVC filter placement; 4 different kinds of filters were used, and anticoagulants were given for Ն3 months.…”

Inferior Vena Cava Filters

“…Although most interventional radiologists readily accept this risk-benefit ratio for IVC filter insertion for patients with document VTE who cannot be on anticoagulation medicine, there are many controversial aspects about IVC filters that are emphasized by our pulmonary and hematological colleagues. [7][8][9][10] Unfortunately, numerous early studies used to answer these difficult questions were historical case series studies with many limitations. Recently, the PREPIC study group conducted an open, randomized, multicenter study of anticoagulation plus vena cava filter placement in 400 patients with acute proximal DVT.…”

“…37 The average incidence of DVT in the general trauma population is 42% (ranging from 18 to 90%) and the reported incidence of PE in patients with spinal cord injury is 10% (range 4 to 22%). Prophylactic IVC filters should be placed in the following high-risk trauma patients with contraindications to anticoagulation 1 : age > 55 years with isolated long bone fracture 2 ; severe head injury with coma 3 ; head injury with long bone fracture 4 ; spinal cord injury with paraplegia or quadriplegia 5 ; multiple long bone fractures with pelvic fracture 6 ; multiple (four or more) long bone fractures 7 ; and penetrating pelvic venous injury. In general, the IVC filters should be placed as soon after injury as possible and retrievable IVC filters should be considered when the risk of PE or contraindication to anticoagulation is anticipated to be short-term (weeks).…”