Developments in Endovascular and Endoscopic Surgery
Retrievable Inferior Vena Cava Filters: Initial Clinical Results

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Anticoagulation is the accepted therapy for patients with thromboembolic disease. When contraindications to anticoagulant therapy are present, however, interruption of the inferior vena cava (IVC) may prevent pulmonary embolism (PE). The objective of this study was to report our early technical and clinical results with retrievable IVC filters (IVCFs) for the prevention of PE. One hundred and twenty-seven multitrauma patients between December 1, 2002, and December 31, 2004, underwent placement of Gunther-Tulip (n = 49), Recovery (n = 41), or OptEase (n = 37) retrievable IVCFs under real-time intravascular ultrasound (IVUS) guidance. All patients had abdominal X-rays to verify filter location. Prior to IVCF retrieval, all patients underwent femoral vein color flow ultrasonography to rule out deep vein thrombosis (DVT) and vena-cavography to assess the IVCF for trapped emboli, filter tilt, or retrained thrombus. Thirty-nine patients died of their injuries; no deaths were related to IVCF placement. One PE occurred during follow-up after filter retrieval, and two femoral vein insertion-site DVTs occurred. One hundred twenty (94.4%) of IVCFs were placed without complication at the L2-3 level, as verified by abdominal X-rays. Filter-related complications included three groin hematomas (2.9%) and three IVCFs misplaced in the right iliac vein early in our experience (2.3%); these filters were uneventfully retrieved and replaced in the IVC within 24 hr. Sixty-six patients underwent uneventful retrieval of IVCFs after DVT or PE anticoagulation prophylaxis was initiated. Forty-five IVCFs were not removed: 41 due to contraindications due to anticoagulation and four because of trapped thrombus within the filter. The role of retrievable IVCFs continues to evolve, but in this study of 127 patients, prophylactic temporary IVCF placement was simple and safe, prevented fatal PE, and served as an effective “bridge” to anticoagulation. Further investigation of this bedside IVUS technique and the role of temporary IVCFs in different patient populations is warranted.

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INTRODUCTION

Anticoagulation is the accepted therapy for patients with venous thromboembolic disease. When contraindications to anticoagulant therapy are present, however, interruption of the inferior vena cava (IVC) can be performed to prevent pulmonary embolism (PE) as >80% of pulmonary emboli originate in the lower extremities and pelvis.1

During the past few decades, a wide variety of permanent IVC filters (IVCFs) designed for percutaneous insertion have been developed. The accepted indications for IVCF

Retrievable IVCFs

Currently, there are three retrievable IVCFs that are approved by the FDA. These filters can be used either permanently or temporarily with subsequent retrieval for PE prevention. They include the Günther-Tulip filter (Cook, Bloomington, IN), the Recovery filter (Bard Peripheral Vascular, Tempe, AZ), and the OptEase filter (Cordis Endovascular, Miami Lakes, FL).

RESULTS

Between December 1, 2002 and December 31, 2004, 127 multiple-trauma patients underwent ICU bedside placement of retrievable IVCFs. One hundred seventeen IVCFs were placed via the right femoral vein and 10 via the left femoral vein. The mean (± SD) age of the patients was 42 ± 2 years (range 17–68), and 77 (60.6%) were male. All patients sustained multiple-trauma injuries (Table I), and the mean (± SD) Injury Severity Score was 27.2 ± 2.2. One hundred thirteen (88.9%) patients had blunt injuries

DISCUSSION

Concerns regarding the long-term safety of permanent IVCFs in young patients and in patients who require short-term PE prophylaxis have created significant clinical interest in using retrievable IVCFs to provide temporary protection against PE.

Three retrievable IVCFs are approved by the FDA: the Günther-Tulip filter, the Recovery filter, and the OptEase filter. A major advantage of using a retrievable IVCF is that it may be removed once DVT intervention is initiated and the patient no longer

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