Saturday, March 01, 2014

Review of IVC filters

This topic was recently reviewed in Current Opinion in Cardiology.

From the abstract:

In the past 18 months, the American College of Chest Physicians released the 9th edition of their guideline for the prevention and treatment of venous thromboembolism. There have also been a number of studies reviewing the use of IVC filters in select populations for the prophylactic prevention of pulmonary embolism. Trauma continues to be the leading indication for prophylactic filters in a number of series, but further studies have demonstrated some benefit of prophylactic filters in the bariatric and spine surgery populations. The IVC filter complication rate remains low; however, so does the retrieval rate for potentially removable filters. These retrieval rates are increased with use of dedicated patient tracking mechanisms. Finally, there have been a number of technology updates in the hardware itself, focusing on strut design.
Summary: Despite little change in the society guidelines, the use of vena cava filters (VCFs) continues to rise. Overall, the use of IVC filters, especially in prophylactic situations, will remain controversial until randomized, controlled trials are performed within each specific patient population.

The use of IVC filters remains non-evidence based with the exception of the indication for acute proximal DVT in a patient with contraindication to anticoagulation. Complications of filters are well appreciated. It was hoped that the introduction of retrieval filters several years ago would help enable wider and safer use of the devices. However, as pointed out in the review retrieval rates are low. Decisions for filter placement are often made in haste during critical situations and explicit discussion of future retrieval is put aside.

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