Regular ArticleRetrievable Inferior Vena Cava filters are not getting retrieved: Where is the gap?
Introduction
Pulmonary embolism (PE) is one of the most severe presentations of deep vein thrombosis (DVT) affecting more than 400,000 to 650,000 patients in the United States and claiming the life of approximately 300000 [1]. The ICOPER registry [2] revealed that approximately 10% of patients with symptomatic PE die within one hour and 15% die within 3 months following acute PE. According to the guidelines from the American College of Chest Physicians (ACCP), anticoagulation is recommended for the routine treatment of PE ( level 1 A), however IVC filter placement is recommended only in those patients with proven PE or DVT with a contraindication for anticoagulation because of risk of bleeding (Grade 1C) [3]. The ACCP guidelines recommended against the routine use of an IVC filter in addition to anticoagulants (Grade 1A).
Although the use of permanent IVC filters has been very popular and resulted in significant reduction in the risk of PE after an 8 year follow up [4], their use did not lead to reduction of mortality and indeed was associated with increased DVT. More recently, Retrievable IVC (RIVC) filters have been introduced with increasing popularity as they can be kept for longer time and at the same time can be retrieved when the primary indication for their usage has been resolved. However, there is clear paucity of good randomized trials evaluating their usage [5]. Moreover, retrieval rates have been low. We sought in this study to evaluate the retrieval rates of IVCF and to discern the factors associated with failure to retrieve those devices after the primary indication for their placement has been resolved.
Section snippets
Methods
We reviewed in this study the electronic medical records of patients who had IVCF placement from January 2004 to June 2008. We included only adult patients (age above 18 years) who had successful RIVCF placement. We excluded all patients that had RIVCF but had died during or after hospitalization, those who decided to leave filter in place (after discussion with physician), those who had attempted unsuccessful retrieval and those who lost to follow –up.
The study was approved by the University of
Results
Over a 4 year period, we identified 351 patients that had IVCF placements. Fig. 1 shows the flow diagram of this study. We have excluded 99 patients (65 died, 24 decided to leave filter in place, 7 had unsuccessful retrieval and 3 lost follow –up). Majority of the filters were placed for surgical patients (161, 63.9%). Among 87 patients with trauma only 29 (33.3%) patients had a VTE indication; the remaining patients had a filter due to contraindication to anticoagulation except for 2 (2.3%)
Discussion
Since its introduction in medical practice [6] IVCF placement has been very popular and potentially over utilized. Stein noted a clear trend for liberalization of the indications for insertion and therefore noted increased potential for unwarranted insertion [7]. Dr. Stein studied a large national database from 50 states and found as striking increase in IVCF placements from 2000 to 49 000 over a 20 year period. It is likely that the introduction of RIVCF and ease of insertions are two major
Conclusion
In this large cohort we found that retrieval rate of RIVCF is extremely low. We found in this cohort that male patients, those who were discharged home and those who were followed by the service that placed the filter have a much higher chance of successful retrieval. We recommend that the procedural service placing the filter should have the ownership of the filter and therefore ought to ascertain adequate follow-up. We are not certain why more males had successful retrieval than females in an
Conflict of interest statement
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Ousama Dabbagh has declared the following conflict of interest: Grant Money paid to the University of Missouri from Bristol Myer Squibb and Pfizer for research studies. Speaker Bureau: Sanofi –Aventis
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Nivedita Nagam MD has no conflict of interest
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Rebecca Chitima-Matsiga MPH has no conflict of interest
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Smitha Bearelly MD has no conflict of interest
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Dilip Bearelly, MD has no conflict of interest
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Racial and ethnic disparities in inferior vena cava filter placement for deep vein thrombosis in the United States
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2022, Journal of Vascular Surgery: Venous and Lymphatic DisordersCitation Excerpt :These rates were similar to reports from other institutions from the same period. Dabbagh et al24 reported a retrieval rate of 18.7% from 2004 to 2008. Another study reported an average retrieval rate of IVCF in Florida and California of ∼6%.21
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2017, Thrombosis ResearchCitation Excerpt :The development of retrievable filters allow for their removal when the indication for filter placement is no longer present and guidelines recommend retrieval to prevent long-term complications [2,5,9,10]. Nevertheless, filter retrieval remains uncommon with studies reporting rates of 5–45% [28–33], comparable to the rate in our cohort. Experts have recommended improving retrieval rates to decrease potential complications of filters [34] and the FDA and Health Canada have recommended removal of IVCF when they are no longer needed [35,36].