Vena caval filters: current knowledge, uncertainties and practical approaches

Abstract

Purpose of review: Inferior vena caval (IVC) interruption has been used as a method to prevent pulmonary embolism since the 1940s. Despite an exponential increase in IVC filter use in both the treatment and prophylaxis of venous thromboembolism, there is little evidence to support current practice. This review will discuss controversies related to IVC filters and will provide a practical approach to their use.

Recent findings: Current practice guidelines recommend that IVC filters be placed in patients with acute proximal deep vein thrombosis and a contraindication to anticoagulation. We do not recommend IVC filters as primary thromboprophylaxis, even for high-risk surgical or trauma patients. We also do not believe that there is a role for IVC filters in cancer patients with venous thromboembolism when traditional anticoagulation has failed. IVC filters have been shown to be associated with an increased risk of recurrent deep vein thrombosis.

Summary: IVC filters are indicated in only a small proportion of patients who have venous thromboembolism. In these situations, retrievable filters are recommended. Anticoagulation should be initiated after filter placement as soon as it is safe to do so and the filter should then be removed shortly thereafter.