Long-Term Retrievability of IVC Filters: Should We Abandon Permanent Devices?

Abstract

Thromboembolic disease produces a considerable disease burden, with death from pulmonary embolism in the UK alone estimated at 30,000-40,000 per year. Whilst it is unproven whether filters actually improve longevity, the morbidity and mortality associated with thromboembolic disease in the presence of contraindications to anticoagulation is high. Thus complications associated with filter insertion, and whilst they remain in situ, must be balanced against the alternatives. Permanent filters remain in situ for the remainder of the patient's life and any complications from the filters are of significant concern. Filters that are not permanent are therefore attractive in these circumstances. Retrievable filters, to avoid or decrease long-term filter complications, appear to be a significant advance in the prevention of pulmonary embolism. In this review, we discuss the safety and effectiveness of both permanent and retrievable filters as well as the retrievability of retrievable inferior vena cava (IVC) filters, to explore whether the use of permanent IVC filters can be abandoned in favor of retrievable filters. Currently four types of retrievable filters are available: the Recovery filter (Bard Peripheral Vascular, Tempe, AZ, USA), the Günther Tulip filter (Cook, Bloomington, IN, USA), the OptEase Filter (Cordis, Roden, The Netherlands), and the ALN filter (ALN Implants Chirurgicaux, Ghisonaccia, France). Efficacy and safety data for retrievable filters are as yet based on small series, with a total number of fewer than 1,000 insertions, and follow-up is mostly short term. Current long-term data are poor and insufficient to warrant the long-term implantation of these devices into humans. The case of fractured wire from a Recovery filter that migrated to the heart causing pericardial tamponade requiring open heart surgery is a reminder that any new endovascular device remaining in situ in the long term may produce unexpected problems. We should also bear in mind that the data on permanent filters are much more robust, with reports on over 9,500 cases with follow-up of up to 8 years. The original implantation time of 10-14 days has been extended to more than 100 days as the mean implantation time with some of the filter types. Follow-up (preferably prospective) is necessary for all retrievable filters, whether or not they are retrieved. Until these data become available we should restrict ourselves to the present indications of permanent and retrievable filters. If long-term follow-up data on larger numbers of cases confirm the initial data that retrievable filters are as safe and effective as permanent filters, the use of the retrievable filters is likely to expand.

Surgical Hemostasis in the Era of Anticoagulation: Guidelines and Recommendations Summary

“…Older patients as well as those with a relatively short life expectancy or a lifelong thrombotic risk can still receive the standard, permanent fi lter. The advent of retrievable IVC fi lters has provided an effective, nonpermanent option for patients with shortterm, reversible conditions requiring PE prevention [ 46 ]. The window for removal is 3-18 months after placement, after which scar tissue, remodeling of the vessel wall, and degradation of the fi lter itself can make retrieval diffi cult or impossible.…”

Retrieval of "Recovery Ivc Filter(tm)" After 383 Days

“…Filter fractures are less frequent and are reported less than 1% in the literature 6 . A few studies and case reports have been published about prolonged temporary implantation with use of "Recovery IVC Filter (TM) " [1][2][3][4][5]8,9 . The first report about the use of "Recovery IVC Filter (TM) " was from Asch in the year 2002 and he reported an average period of implantation 53 days (5-134 days) in which out of 32 implanted filters, 26 were successfully retrieved.…”

“…Long-term placement of cava filter constitutes a safe alternative for the prophylaxis of PE in high risk patients especially patients in thrombophilic state, patients with polytrauma, immobile patients with brain and spine injuries and in patients with DVT complicated by PE [1][2][3][4][5] . For long-term vena cava filtration, permanent filters are commonly used, however long-term placement of these filters is associated with a high degree of complication.…”

“…Retrieval of "Recovery IVC Filter (TM) " after 383 days Generally it is known that the period of implantation of the filter with safe removal is decided by the manufacturer and is up to 14 days ("Opt Ease Filter" has approved period of implantation of 23 days in USA). These days in the market, a few types of filters are commonly used, which are approved to be removable or permanent and can be utilized for prolonged temporary implantation with late removal 1,5 . These are "Opt Ease Filter" (Cordis, Warren, NJ), "Günther Tulip Filter" (Cook, Bloomington, IN, USA) and "Recovery IVC Filter (TM) " (Bard Peripheral Vascular, Tempe, AZ, USA), up-grade version "Recovery G2 IVC Filter"(Bard).…”

Advanced Techniques for Removal of Retrievable Inferior Vena Cava Filters

“…During the last 3 years, in the United States, the percentage of annually placed optional filters, i.e., filters than can remain as permanent filters or potentially be retrieved, has consistently exceeded that of permanent filters [1][2][3]. In parallel, the complications of long-or short-term filtration have become increasingly evident to physicians, regulatory agencies, and the public [4][5][6][7][8][9][10][11][12][13][14]. Among these complications are caval thrombosis, extension of lower-extremity deep vein thrombosis (DVT) [13], caval or adjacent vessel perforation (e.g., aorta, lumbar artery, renal artery, common iliac artery) [15][16][17][18][19][20][21][22][23], penetration of adjacent viscera (e.g., duodenum, liver parenchyma, pancreatitis) [17,[24][25][26][27], embedding within adjacent bony structures [15,28,29], whole or partial migration, device fracture, and embolization [15,[30][31][32][33][34][35][36][37][38][39]…”