The role of temporary inferior vena cava filters in critically ill surgical patients

Abstract

Hypothesis: Prophylactic temporary inferior vena cava (IVC) filters are safe and effective in critically ill patients at high risk for venous thromboembolism.

Design: Prospective cohort study.

Setting: Urban level I trauma center.

Subjects: Multiple-trauma patients and critically ill surgical patients undergoing prophylactic temporary IVC filter placement. All patients were at high risk for venous thromboembolism but had contraindications to low-dose heparin therapy.

Interventions: The interventional radiologist used the femoral or internal jugular approach to place a removable IVC filter in all patients. The filter was removed when the patient could safely be treated with heparin. If the filter could not be removed by 14 days, it was relocated to prevent incorporation precluding retrieval.

Main outcome measures: Complications of filter insertion and removal, deep venous thrombosis, and pulmonary embolism.

Results: From May 1, 2001, to October 1, 2002, 44 patients underwent placement of temporary IVC filters. Thirty-seven patients (84%) were severely injured. The mean +/- SD age was 37 +/- 3 years, and 55% were men. The mean +/- SD Injury Severity Score of the trauma patients was 33 +/- 2, and all had blunt injury. There were no complications associated with filter insertion or removal. Nine patients required filter relocation prior to retrieval. Three filters could not be removed: 2 secondary to significant clots trapped below the filter and 1 because of angulation resulting in the inability to grasp the filter. There were no documented instances of venous thromboembolism following IVC filter placement and removal.

Conclusions: Temporary IVC filters are safe and effective in critically ill surgical and trauma patients and allow an aggressive approach to prevention of venous thromboembolism in this challenging group of patients.