Safety and efficacy of removable inferior vena cava filters in anticoagulated patients undergoing percutaneous nephrostolithotomy

Abstract

Background and purpose: Increasing numbers of patients are receiving a diagnosis of thrombophilic conditions necessitating chronic anticoagulation therapy. The best management approach for such patients needing percutaneous nephrostolithotomy (PCNL) has not been established. Discontinuing anticoagulation therapy before PCNL is needed to prevent hemorrhage, placing some of these patients at risk for thromboembolic events. We describe the use of removable inferior vena cava filters (RIVCF) in patients undergoing PCNL who are at risk for a venous thromboembolic event.

Patients and methods: A retrospective study of outcomes of PCNL with RIVCF placement was conducted.

Results: Four patients underwent PCNL with RIVCF placement on the same day of the procedure. The mean age was 49 years (range 35-69 years). PCNL was performed on a total of six renal units with a mean of 2.2 (range 1-3) operations per renal unit. Five of six (83%) renal units were rendered stone free. There were no complications associated with either the PCNL or RIVCF placement. No patient had a thromboembolic event or received blood products. Two of the four patients underwent successful removal of the RIVCF, and one elected to keep the device in place. The device could not be extracted in the other patient. The average length that the filters were in place was 52.5 days. Patients resumed anticoagulation therapy shortly after RIVCF removal.

Conclusion: RIVCF placement is a safe and effective method of preventing venous thromboembolic complications in thrombophilic patients needing PCNL. Patients should be informed, however, that RIVCF removal is not always possible.