Optional vena cava filters: preliminary experience with a new vena cava filter

Abstract

Purpose: To prevent pulmonary embolism, some clinical situations only need a vena cava filter for several days, without the inconveniences of temporary vena cava filters in the short-medium term and without the drawbacks of permanent ones in the long term. We report our initial experience with a new definitive vena cava filter, easy to retrieve when it becomes unnecessary.

Material and methods: From the beginning of January 1999 to December 2001, 18 ALN vena cava filters were deployed. The approach used was transbrachial in ten patients, transjugular in seven, and transfemoral in the others. The indications were pelvic trauma in eleven patients, hip replacement in three; four filters were "prophylactically" placed before surgery in patients at high risk of thromboembolic disease (three with ileal or femoral or ileo-femoral thrombosis, and one without clinically manifest thromboembolic disease). Optional vena cava filters were evaluated for malpositioning, caval perforation, filter migration, acute caval thrombosis or access site thrombosis. Seven optional vena cava filters were retrieved. CT was performed before retrieving the vena cava filters to document the absence of thrombi inside the filters. The transjugular ap-proach was used to retrieve the filters.

Results: Technical success was achieved in all patients. No complications were encountered during the procedure; no migration or rupture of the filters was detected during the follow-up. No thrombosis of the vena cava or at the insertion site was encountered. The median retrieval time for the filters was 12': only the transfemoral filters required 15' of fluoroscopy. The median permanence was 63 days. No thrombi were found inside the filters.

Discussion: A definitive vena cava filter, easy to retrieve when it becomes unnecessary, is the ideal device in many clinical conditions: young subjects with pelvic fractures orthopaedic and gynaecologic interventions.