Prophylactic Insertion of Optional Vena Cava Filters in High-Risk Trauma Patients

Abstract

Ab stractBackground: Vena cava interruption is a form of pulmonary embolism prophylaxis that is being used in high-risk patients who do not tolerate pharmacologic prophylaxis. Retrievable prophylactic vena cava filters (VCFs) are of particular interest for severely injured patients where the necessity for VCF is often only temporary. Methods: In a single-institution case series of consecutive patients who received prophylactic VCFs after polytrauma, between 04/1998 and 07/2004, the demographic data, injury pattern and complications were analysed. Results: Ninety-five prophylactic VCFs were placed in polytrauma patients (median ISS of 38). Median age was 38 years (range 16-80 years). Median delay between trauma and filter placement was 1 day (range 0-31 days). No complication was seen related to filter insertion or retrieval. Sixty-five VCFs (68.4%) were retrieved after 4-25 days (median 13 days). One filter migration (1.1%) was observed. Retrieval failed in two patients (3.0%). A total of 30 VCFs (31.6%) were left permanently. One nonfatal PE (1.1%) occurred 21 days after filter retrieval despite prophylaxis with LMWH. DVT developed in two patients (2.1%) including one vena caval occlusion (1.1%). Overall mortality was 7.4%. Conclusions: Early prophylactic placement of VCF in a high-risk trauma patient should be considered when anticoagulation is contraindicated. Filter insertion and retrieval is safe with a low complication rate.

Early Placement of Optional Vena Cava Filter in High-Risk Patients with Traumatic Brain Injury

“…Prophylactic insertion of optional VCF in high-risk patients has shown to provide effective protection from potentially fatal PE with low insertion -and retrieval related morbidity [24][25][26][27][28]. With the safety of LDUH and LMWH not being established yet, early placement of VCF may be an alternative method of PE prophylaxis in TBI patients with severe additional injuries at risk for potential intracranial bleeding complications.…”

“…Retrieval rate reached 52% with a mean indwelling time of 71 days. In a previous study, we reported our experience with prophylactic insertion of optional VCF in multiple injured patients with a median ISS of 38 [26]. From a total of 95 VCF placed before August 2004 68% were retrieved after 13 days with a maximal indwelling time of 25 days.…”