Abstract 19396: Role and Factors Associated With Removal of Retrievable Inferior Vena Cava Filter in Venous Thromboembolism
It has been recommended that implanting physicians and clinicians responsible for the ongoing care of patients with retrievable inferior vena cava filters (IVCFs) consider removing the filter as soon as protection from pulmonary embolism (PE) is no longer needed. To investigate factors associated with IVCF retrieval, we studied 228 consecutive patients with venous thromboembolism (VTE) in whom retrievable IVCFs were placed to prevent massive PE. The mean age of the patients was 66 years (range, 17-96 years), and 118 (52%) of them were female. Of the 228 patients, 76 (33%) had PE. In addition to VTE, major underlying conditions were trauma (24%), malignancy (18%), central nervous system disturbance (18%), cranial hemorrhage (6%), gastrointestinal tract bleeding (12%), other hemorrhagic events (11%), patient non-compliance (9%), and inability to anticoagulant after surgery (4%). After IVCF placement, no PE events were recorded with the IVCF in place. Of the 228 patients 35 died of underlying diseases, in whom IVCF removals were not attempted due to the severity or the prognosis of underlying diseases. Of the other 193 patients, 64 non-surgical retrieval attempts (33%) were made. Retrieval attempts were increased after the retrieval recommendation by the Food and Drug Administration in 2010 (p<0.05). Fifty five IVCFs (86%) were successfully removed. Unsuccessful retrieval attempts were made in 8 patients because of embedded IVCF or clot within the IVCF. The median retrieval time after filter placement was 20 days (range, 3 to 144 days). No complications of filter retrieval were documented. Those attempted were younger than not attempted (54±18 years vs 70±14 years, p<0.05). Those with central nervous system disturbance, any hemorrhage events, malignancy, or patient non-compliance were related to lower retrieval attempts than those with trauma. One surgical removal was made in a 91 year-old-female with severe shooting pain due to caval penetration 2.3 years after implantation. In conclusions, IVCF placement was thought to be effective to prevent PE in our patients. Underlying conditions and the use of IVCFs in older age were at least partly associated with a lower retrieval rate. Further efforts are needed to improve the rate of IVCF retrieval.
Author Disclosures: Y. Doi: None. K. Hirooka: None. K. Okada: None. M. Nishio: None. K. Miyazaki: None. A. Sakatani: None. T. Nagano: None. R. Matsuoka: None. M. Morita: None. T. Otani: None. T. Natsukawa: None. H. Sawano: None. T. Kai: None. T. Hayashi: None.
- © 2016 by American Heart Association, Inc.