An Australian experience of retrievable inferior vena cava filters in patients with increased risk of thromboembolic disease

Abstract

Aim: Pulmonary embolism (PE) is a common cause of death and morbidity. Anticoagulant therapy reduces the risk of PE but is associated with bleeding. Inferior vena caval (IVC) filters protect against PE but have an increased long term risk of deep vein thrombosis (DVT). Temporary IVC filters allow protection against PE during high risk situations and may be later removed avoiding the need for long term anticoagulation.

Methods: We present our experience with the Recovery (Bard, Tempe, AZ) and Tulip (Cook, Bloomington, IN) optionally retrievable filters.

Results: Retrievable filters were planned for 121 patients. Mean age: 58.8 years; 72 male. The indications included: Established venous thromboembolism (VTE) and contraindication to anticoagulation; high risk of VTE and need for surgery with high risk of bleeding; VTE extension despite anti-coagulation. A retrievable filter was placed without significant incident in 113 patients. There were two proven cases of PE. In total there were 27 deaths of patients during the period of their follow up. There was 1 death related to confirmed filter migration. There was 1 sudden unexplained death in a patient with suspected malignancy. Filter removal was attempted in 58 cases at a mean of 44 days and was performed successfully in 52. Thromboembolus was found in the retrieved filter in 30 cases but did not prevent removal in 29.

Conclusion: Retrievable IVC Filters are safe and effective in preventing PE in high risk patients. We have demonstrated success in retrieving filters up to 182 days following insertion, avoiding the need for long term anticoagulation.