Contemporary Management of Chronic Indwelling Inferior Vena Cava Filters: A Single-Institution Experience
Ivanics T, Williams P, Nasser H, Leonard-Murali S, Schwartz S, and Lin J. Contemporary Management of Chronic Indwelling Inferior Vena Cava Filters: A Single-Institution Experience. J Vasc Surg-Venous L 2020; 8(2):325-327.
J Vasc Surg-Venous L
Objective: Despite increasing retrieval rates of the inferior vena cava (IVC) filter, less than one-third are removed within the recommended time. Prolonged filter dwell times may increase the technical difficulty of retrieval and filter-related complications. We sought to evaluate contemporary outcomes of patients with chronic indwelling IVC filters at a tertiary care center. Methods: From 2015 to 2019, a retrospective analysis was performed of all patients who were referred for removal of prolonged IVC filter with a dwell time >6 years. Descriptive analyses were used to evaluate patient characteristics and procedural outcome by electronic medical records. Data were expressed as the mean and standard deviation, median with interquartile range (IQR), or number and percentage, as appropriate. Results: During the study period, a total of 45 patients were identified with a median filter dwell time of 9.0 years (IQR, 6-13 years); 32 patients underwent removal of IVC filter and 13 patients refused retrieval. The median age of patients was 55.3 years (IQR, 42.6-66.5 years); the majority were female (55.6%) and white (60.5%). Comorbidities included history of venous thromboembolism (80%), hypercoagulable state (13.3%), hypertension (55.6%), diabetes (24.4%), hyperlipidemia (31.1%), chronic kidney disease (11.1%), and active smoking status (11.1%). IVC filters removed included 12 (26.7%) Günther Tulip (Cook Medical, Bloomington, Ind), 5 (11.1%) Celect (Cook), 4 (8.9%) G2 (Bard, Murray Hill, NJ), 2 (4.4%) Greenfield (Boston Scientific, Marlborough, Mass), 1 (2.2%) Simon Nitinol (Bard), 1 (2.2%) OptEase (Cordis, Bridgewater, NJ), and 1 (2.2%) Recovery (Bard). The most common indication for filter placement was high risk despite anticoagulation (52.4%), followed by venous thromboembolism prophylaxis (21.4%) and inability to be anticoagulated (19.0%). The majority of the patients were symptomatic (66.7%). If symptomatic, the most common reason for retrieval was filter migration (62.1%), and chief complaint was pain (51.7%). The time from first clinic visit or consultation until IVC filter removal was a median of 34.0 days (IQR, 14.8-62.8 days). Retrieval success was 95% (standard deviation, 0.20), with a median length of stay of 0 days. Most retrievals were performed through an endovascular approach, and interventional radiology performed the majority of retrievals (n = 24 [75.0%]). None of the patients who underwent retrieval (n = 32) developed a postprocedural complication. Conclusions: Despite prolonged dwell times, IVC filter retrieval can be performed safely and effectively in carefully selected patients at a tertiary referral center.