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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 [1,2]. Transvenous interruption of the vena cava became clinically feasible in 1967, eliminating the need for general anesthesia and laparotomy to perform surgical interruption [3,4].

The only widely accepted and validated indications for IVC filter placement in patients with thromboembolism are: an absolute contraindication to therapeutic anticoagulation, and failure of anticoagulation when there is acute proximal venous thrombosis. Other possible treatment indications are more controversial. These are discussed in more detail elsewhere. (See "Treatment of acute pulmonary embolism", section on 'IVC filters' and "Treatment of lower extremity deep vein thrombosis", section on 'Inferior vena cava filter'.)

Given the vagueness of some of the indications, it is not surprising that the use of IVC filters varies widely [5,6]. With the increased ease of percutaneous filter placement and the introduction of retrievable devices, IVC filters are increasingly used for prophylaxis in patients with a high risk of developing venous thrombosis. Prophylactic filter placement has been used as an alternative to pharmacologic or mechanical prophylaxis (ie, sequential compression devices) in patients with traumatic injuries and in those undergoing spinal, neurosurgical, or bariatric surgery [7-14].

The placement and complications associated with inferior vena cava filters are discussed 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".)

TYPES OF FILTERS

A number of percutaneous IVC filters have been developed since the introduction of the original Greenfield filter (figure 1). The newer devices are designed to optimize flow dynamics, maximize clot-trapping capacity, expedite ease of insertion and allow for future removal [1,2,15,16].

       

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Literature review current through: Jun 2014. | This topic last updated: Sep 10, 2013.
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