Prophylactic placement of an inferior vena cava filter in high-risk patients undergoing spinal reconstruction

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The purpose of this study was to evaluate the safety and efficacy of prophylactic inferior vena cava (IVC) filter placement in high-risk patients who undergo major spine reconstruction.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In the pilot study, 22 patients undergoing major spine reconstruction received prophylactic IVC filters. These patients were prospectively followed to evaluate complications related to the filter, the rate of deep venous thrombosis (DVT) formation, and the rate of pulmonary embolism (PE). These data were compared with those obtained in a retrospective review for PE in a matched cohort treated at the same institution. At a second institution the treatment guidelines were implemented in 17 patients undergoing complex spine surgery with the same follow-up criteria.</jats:p> <jats:p>In the pilot study, no patient experienced PE (0%), whereas two had DVT (9%). Bilateral DVT developed postoperatively in one patient (associated morbidity rate 4.5%), who required thrombolytic therapy. One patient died of unrelated surgical complications. The PE rate in the matched cohort at the same institution was 12%. At the second institution, no patient had PE, and no complications were noted.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In this patient population, prophylactic IVC filter placement appears to decrease the PE rate substantially, from 12 to 0%. The placement of IVC filters appears to be a safe and efficacious intervention for prevention of PE in high-risk patients.</jats:p></jats:sec>

Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis

“…In a randomized study looking at the efficacy of different compression devices, including a subgroup of cases receiving coumarine anticoagulation, Rokito et al [12] found a very low DVT rate (0.3%) and no symptomatic PE. In contrast, Rosner et al [13], using a retrospective cohort of high-risk patients as a control group to study the routine use of IVCF as a form of thromboembolic prophylaxis, found a much higher rate of PE (13.1%). Nevertheless, their group was not representative of the average spinal practise and for that reason their findings were not included in our statistic describing the average incidence of PE from the literature (see Table 2).…”

“…DVT incidence has been reported to range from 0% [12] to 15.5% [11] with PE incidence varying from 0% [12] to 13.1% [13]. Although DVT has been studied extensively in the context of spinal surgery, symptomatic PE, which in itself is life threatening, has been given less attention.…”

Vena cava filters are not superior to low molecular weight heparin in venous thromboembolism prophylaxis: a study on long term immobilized neurosurgical patients

“…Ozturk et al reported a significant decrease in PE risk in their study on 129 patients with similar characteristics (24). In the literature, there are case series, performed on a lower number of patients, pointing to the use of vena cava filters in patients subjected to complex spinal surgery as a safe and effective method in preventing PE (8,20,28). In the present study, pulmonary embolism was not reported in both groups.…”

“…Pharmacological agents might result in catastrophic complications in the peri-and postoperative period and their use is therefore not considered to be beneficial (1,6,7,23,18,19). Although absolute and relative indications of vena cava filters are still debatable, their prophylactic use in patients with neurosurgical problems has not been reported thoroughly in the literature (8,10,20,22,24,26,28).…”

Robotic-Assisted Inferior Vena Cava Filter Retrieval

“…Because of her high risk of VTE recurrence, we elected to place a temporary IVC filter for perioperative VTE protection. [11][12][13] Safety and timing of filter retrieval has been an area of growing concern in the medical literature. A wide array of pathophysiological and social obstacles are faced by physicians in these cases, negatively impacting filter retrieval rates.…”