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Placement of inferior vena cava filters and their complications

INTRODUCTION

Surgical interruption of the inferior vena cava (IVC) to prevent pulmonary embolization was first suggested by Trousseau in 1868 and subsequently performed by Bottini in 1893 [1,2]. In 1959, Moretz first described external clipping of the inferior vena caval by means of a clip that created a single slitlike channel [3]. This development was followed by the introduction of the serrated Miles and Adams and DeWeese devices that created four channels within the IVC [4].

Transvenous interruption of the vena cava, eliminating the need for general anesthesia and a laparotomy, became clinically feasible in 1967 with the introduction of the Mobin-Uddin filter [5,6]. Due to the unacceptably high incidence of IVC occlusion associated with use of this device, the Kimray-Greenfield filter, introduced into clinical practice soon thereafter, became the preferred device for transvenous caval interruption [7,8].

The indications for and complications of IVC filters are presented here. Other treatment of deep venous thrombosis and acute pulmonary embolism are discussed separately. (See "Low molecular weight heparin for venous thromboembolic disease" and "Treatment of acute pulmonary embolism" and "Fibrinolytic (thrombolytic) therapy in acute pulmonary embolism and lower extremity deep vein thrombosis".)

INDICATIONS

The only widely accepted and validated indications for IVC filter placement in patients with thromboembolism are listed below. These are discussed in more detail elsewhere (see "Treatment of lower extremity deep vein thrombosis" and "Anticoagulation in acute pulmonary embolism").

  • Absolute contraindication to therapeutic anticoagulation
  • Failure of anticoagulation when there is acute proximal venous thrombosis

        

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Literature review current through: Apr 2013. | This topic last updated: Jun 21, 2012.
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