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Using inferior vena cava filters to prevent pulmonary embolism

Richard J.T. Owen, MB BCh FRCP
Academic interventional radiologist in the Department of Radiology and Diagnostic Imaging at the University of Alberta and is Treasurer of the Canadian Interventional Radiology Association

Correspondence to: Dr Richard Owen, Department of Radiology and Diagnostic Imaging, University of Alberta, Walter Mackenzie Health Sciences, 844—112 St, Edmonton, AB T6G 2B7; telephone 780 407-1210; e-mail drrichardowen{at}tbwifi.ca

OBJECTIVE To review the evidence for using inferior vena cava (IVC) filters to prevent pulmonary embolism (PE) in high-risk patients.

QUALITY OF EVIDENCE Ovid MEDLINE was searched from 1966 to 2006 for all English-language papers on IVC filters. Evidence was graded according to the 3-level classification system. Most evidence found was level II.

MAIN MESSAGE Inferior vena cava filters are used to prevent PE in patients with contraindications to, complications of, or failure of anticoagulation therapy and patients with extensive free-floating thrombi or residual thrombi following massive PE. Current evidence indicates that IVC filters are largely effective; breakthrough PE occurs in only 0% to 6.2% of cases. Contraindications to implantation of IVC filters include lack of venous access, caval occlusion, uncorrectable coagulopathy, and sepsis. Complications include misplacement or embolization of the filter, vascular injury or thrombosis, pneumothorax, and air emboli. Recurrent PE, IVC thrombosis, filter migration, filter fracture, or penetration of the caval wall sometimes occur with long-term use.

CONCLUSION When used appropriately, IVC filters are a safe and effective method of preventing PE. Using retrievable filters might reduce long-term complications.