Surgery

Inferior Vena Cava Filter

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Inferior Vena Cava Filter, Vena Cava Filter, IVC Filter, Greenfield Filter

  1. Anticoagulation contraindicated (Fall Risk, Bleeding risk)
    1. High risk Hypercoagulable patients or
    2. High risk of Pulmonary Embolism (e.g. proximal DVT)
      1. Prolonged bed-bound status (e.g Trauma, paralysis, Severe Head Injury, Hip Fracture, Pelvic Fracture, Bariatric Surgery)
  2. Complication secondary to Anticoagulation
    1. Failed Anticoagulation
      1. Deep Vein Thrombosis extension
      2. Pulmonary Embolism despite Anticoagulation with therapeutic levels
    2. Hemorrhage
    3. Thrombocytopenia
    4. Warfarin skin necrosis
    5. Noncompliance with Anticoagulation protocol
  • Efficacy
  1. Lower Incidence of Pulmonary Embolism
  2. Does not reduce overall mortality
  3. Decousus (1998) N Engl J Med 12:338(7):409-15 [PubMed]
  4. Young (2010) Cochrane Database Syst Rev, CD006212
  • Complications
  1. Overall complication rate: 1-2%
  2. Early complications
    1. Malpositioned IVC Filter (e.g. tilted)
    2. Insertion site Hematoma
    3. Deployment complication (e.g. filter fails to open completely)
  3. Late complications
    1. IVC Filter migration (e.g. into right atrium or superior vena cava)
    2. IVC Filter tilted or otherwise malpositioned
    3. IVC thrombosis
    4. IVC perforation (e.g. due to IVC Filter leg or strut fracturing)
      1. Retroperitoneal Hematoma
      2. Aortic pseudoaneurysm
      3. Duodenal perforation
      4. Pancreatic injury
      5. Vertebral body injury
      6. Iliopsoas Muscle injury
  4. References
    1. Shang (2011) Vasc Endovascular Surg 45(3): 290-4 [PubMed]
  • Precautions
  1. IVC Filters should only be used as bridging devices and then removed
    1. Risk of Pulmonary Embolism wanes
    2. Anticoagulation is no longer contraindicated
  2. FDA recommends removal of IVC Filter when no longer indicated
    1. However removal is difficult and fails in up to 8% of cases
    2. Lee (2015) Cardiovasc Intervent Radiol 38(6): 1502-7 [PubMed]
  • References
  1. Shoenberger and Bright in Majoewsky (2013) EM:Rap 13(6): 8
  2. Girard (2002) Chest 122:963-7 [PubMed]