Suprarenal inferior vena cava filters: a 20-year single-center experience

Abstract

Purpose: To assess the clinical safety and efficacy of suprarenal inferior vena cava (IVC) filters during long-term follow-up.

Materials and methods: In this retrospective study, the authors collected the following data about patients who underwent suprarenal IVC filter placement at their institution between 1988 and 2007: demographics, clinical presentation, indications for filter placement, reasons for placing the filter in the suprarenal IVC, type of filter, frequency of pulmonary embolism (PE) after filter placement, and filter-related problems during follow-up.

Results: Seventy patients (32 male and 38 female patients; mean age, 60 years) had suprarenal IVC filters. Sixty-two patients presented with symptoms of venous thromboembolism (VTE) and eight had incidental asymptomatic VTE at imaging. Indications for filter placement were as follows: contraindication to anticoagulation (n = 48), complications and/or failure of anticoagulation (n = 12), added protection (n = 8), and prophylaxis (n = 2). Suprarenal placement was chosen due to IVC thrombus (n = 41), intrinsic and/or extrinsic narrowing of the infrarenal IVC (n = 9), renal and/or gonadal vein thrombus (n = 3), congenital IVC anomalies (n = 6), pelvic mass (n = 5), pregnancy (n = 3), and other reasons (n = 3). The following filters were used: Greenfield (n = 29), Simon Nitinol (n = 5), Vena-Tech (n = 3), TrapEase (n = 22), OptEase (n = 3), Tulip (n = 6), Bird's Nest (n = 1), and Recovery (n = 1). During follow-up (mean, 573 days +/- 953), postfilter PE was suspected in 10 patients; eight patients underwent computed tomography (CT), one of whom had PE at CT. None developed new symptoms of caval thrombosis. Abdominal CT (performed in 30 patients at a mean of 543 days +/- 768) showed thrombus in the filter in three patients, fracture in one patient, and penetration of the IVC wall in two patients.

Conclusions: Suprarenal filters are safe and effective in preventing PE. The placement of IVC filters above the renal veins does not carry an added risk of complications.