A review of inferior vena cava filters.
Tong, Emma; Lee, Michael J; Sheahan, Kevin P
The care of patients with venous thromboembolism (VTE) is delivered via a multidisciplinary team. The primary treatment for VTE is anticoagulation; however, placement of filter devices in the inferior vena cava (IVC) to prevent embolisation of deep venous thrombosis (DVT) is a well-established secondary treatment option. Many controversies remain regarding utilisation and management of filters. There are two types of IVC filters, non-retrievable (permanent) and retrievable (optional). We reviewed the literature on the type of IVC filters, indications for placement, contemporary guidelines for placement, complications, management and potential future guidance.
Guidelines differ in their recommendations in these clinical scenarios, however, do concur that retrievable IVC filters are indicated in patients with VTE who have an absolute contraindication to anticoagulation. Broader indications for IVC filters have expanded, however, despite no data demonstrating a mortality benefit, IVC filter use has increased consistently.
Unretrieved filters can lead to DVT, filter migration/embolisation, filter fracture, IVC perforation, and filter-related caval thrombosis. Structured follow-up programs increase retrieval rates, and detect and potentially reduce complications. Multidisciplinary pulmonary embolism response teams (PERTs) have been developed, which could reduce unnecessary IVC filter placements, and facilitate follow up in a specific VTE clinic and could lead to higher filter retrieval rates.
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