A single center 9-year experience in IVC filter retrieval - the importance of an IVC filter registry

Managing an effective system for retrieving IVC filters: outcomes of a prospective patient database, 2012-2023

PURPOSE

To evaluate retrievable inferior vena cava (IVC) filter outcomes with a prospectively maintained database and active patient management by interventional radiology (IR).

MATERIALS & METHODS

Patients with retrievable IVC filters placed by IR from 2012 to 2023 at a single, tertiary institution were tracked in a prospective registry, and follow-up was organized by a designated IR physician assistant. Patients were contacted after the filter was placed by IR and a clinic visit arranged; filter removal was scheduled when deemed appropriate. Retrospective review of filter outcomes, including retrieval, patient death, and need for permanent filtration, was performed.

RESULTS

Over the 12-year study period, 607 retrievable IVC filters were placed: 516 Denali, 63 Eclipse, 19 Günther Tulip, and 9 Celect Platinum. In total, 43% (260) were retrieved, 12% (75) were adjudicated to be permanent, and 42% (253) died with the filter in place. The remaining 3% (19) comprised patients alive with the filter not yet retrieved at study endpoint, 42% (8/19) of which were placed in 2023. Of this cohort, 8 still needed the filter and were being monitored to determine follow-up timing, 2 needed a follow-up appointment, and 9 were lost to follow-up due to repeated no-shows and/or inability to reach the patient despite multiple attempts. Overall, 1.5% (9/607) of all filters placed were not accounted for.

CONCLUSION

This study demonstrates high accountability (98.5%) of retrievable IVC filters when using a prospective registry actively managed by an IR PA, providing an effective and feasible model for facilitating appropriate follow-up.

Appropriateness guidelines for inferior vena cava filter utilization: A contemporary review

Concern regarding the exponential increase in optional utilization of inferior vena cava filters (IVCFs) in the early 2000s with a persistent low retrieval rate nationwide has resulted in increased scrutiny regarding clinical application of IVCFs. IVCFs are used in a variety of clinical scenarios, ranging from thromboembolic protection in patients with deep venous thrombosis and contraindication to anticoagulation to prophylactic deployment in multitrauma and critically ill patients. Evidence supporting IVCFs as mechanical thromboembolic protection in certain clinical scenarios has been established through evidenced-based guidelines. As an adjunct to evidence-based guidelines, appropriateness criteria to address specific clinical scenarios and facilitate clinical decision making when considering placement of an IVCF have been developed. In this review, current evidence-based and appropriateness guidelines are summarized.

How I approach the prevention and treatment of thrombotic complications in hospitalized patients

This article uses case-based discussion to review prevention and management of thrombotic problems in hospitalized patients that involve a clinical hematologist. There is variation in the clinical hematologist's role in thrombosis practice throughout the world, and we discuss this where indicated. Hospital-associated venous thromboembolism (VTE), or hospital-associated thrombosis (HAT), is the term to cover VTE occurring during admission and for 90 days postdischarge and is a common patient safety problem. HATs are the most common cause of VTE accounting for 55% to 60% of all VTE, with an estimated 10 million occurring globally. VTE risk assessment alongside evidence-based thromboprophylaxis reduces this risk significantly. Many hospitalized patients, especially older patients, use direct oral anticoagulants (DOACs), mainly to prevent stroke in atrial fibrillation. DOACs require perioperative management and may need urgent reversal. Other complex interventions such as extracorporeal membrane oxygenation which require anticoagulation are also discussed. Lastly, those with uncommon high-risk thrombophilias, especially those with antithrombin deficiency, produce unique challenges when hospitalized.

A review of inferior vena cava filters

The care of patients with venous thromboembolism (VTE) is delivered via a multidisciplinary team. The primary treatment for VTE is anticoagulation; however, placement of filter devices in the inferior vena cava (IVC) to prevent embolisation of deep venous thrombosis (DVT) is a well-established secondary treatment option. Many controversies remain regarding utilisation and management of filters.