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Inferior vena cava filters

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 pulmonary embolism and deep vein thrombosis".)

INDICATIONS

The only widely accepted and validated indications for IVC filter placement are:

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