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. 2017 Mar-Apr;23(2):144-149.
doi: 10.5152/dir.2016.16022.

Ten-year experience of retrievable inferior vena cava filters in a tertiary referral center

George Tse  1 , Trevor Cleveland, Stephen Goode
Affiliations

Ten-year experience of retrievable inferior vena cava filters in a tertiary referral center

George Tse et al. Diagn Interv Radiol. 2017 Mar-Apr.

Abstract

Purpose: A significant proportion of patients undergoing surgery have an increased incidence of acute pulmonary embolus (PE). We analyzed all patients who had a retrievable inferior vena cava (IVC) filter placed preoperatively for PE prophylaxis and investigated the long-term outcomes of the patients who did not have their filter removed.

Methods: Patients who underwent retrievable IVC filter insertion and attempted removal were identified from the radiology information systems database in a large tertiary referral university teaching hospital. Results of all clinical investigations (including computed tomography, magnetic resonance imaging, ultrasonography, and plain radiography) while the IVC filters were in situ were reviewed.

Results: In total, 393 retrievable IVC filters were inserted, 254 with the indication of preoperative thromboembolic prophylaxis. Recurrent PE was reported in five patients (1.9%) despite the IVC filter. Of the 254 retrievable filters inserted prior to surgery, an attempt at retrieval was made in 168 filters (66.1%). Successful retrieval at the first attempt occurred in 143 cases (85.1%), while 25 cases failed or were aborted (14.9%). No attempt at retrieval was made in 86 (33.9%) patients and a significant proportion of these patients had undergone cancer surgery (P < 0.0107). In those patients where there was no attempt at retrieval, there was an association between cancer surgery and a shorter absolute survival time (P < 0.0001).

Conclusion: The majority of attempted filter retrievals were successful, and a proportion of nonretrieved IVC filters are accounted for in patients who underwent cancer surgery and ultimately died with the filter in situ. A departmental protocol is recommended to ensure the filter is removed where appropriate and possible.

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Conflict of interest statement

Conflict of interest disclosure

The authors declared no conflicts of interest.

Figures

Figure 1
Figure 1
Time from insertion to retrieval categorized (percentage of total attempted retrievals, n=168).
Figure 2. a–e
Figure 2. a–e
Reasons for nonretrieval of inferior vena cava (IVC) filter. Digital subtraction images (a–e) showing a moderate sized thrombus occluding filter (Denali filter) (a); small thrombus (b) in the same patient as in (a) after two months of anticoagulation; large occlusive thrombus (recovery filter) (c); angled filter (recovery filter) (d); filter legs penetrating IVC wall (Gunther Tulip filter) (e).
Figure 3
Figure 3
Time from insertion to initial retrieval attempt comparing failed and successful attempts (Mann-Whitney U test, P = 0.817).
Figure 4
Figure 4
Survival in patients where no retrieval was attempted (Log-rank P < 0.0001).
See this image and copyright information in PMC

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