Mid- and long-term outcome of patients with permanent inferior vena cava filters: a single center review.

Inferior vena cava (IVC) filters are used to prevent pulmonary embolism (PE), especially in patients with active contraindication to systemic anticoagulation. The aim of this study is to examine the outcomes of patients who received permanent IVC filters at our institution. This is a single-center retrospective observational study with review of a prospectively collected database for patients who had permanent IVC filters. Patient demographics, indications of filter placement, postprocedure clinical outcome and complications, as well as use of anticoagulant therapy were documented. Chi-squared test was used to test for statistically significant differences (IBM SPSS version 21; IBM Corp., Armonk, NY), while survival was calculated using Kaplan-Meier survival curves analysis. Between February 1998 and December 2013, a total of 109 patients with a median age of 65 (47 men, range 19-97) years had IVC filters inserted at our institution. All of them had documented venous thromboembolism (VTE) before filter placement: 99 (90.8%) had lower extremity deep vein thrombosis (DVT) (including 34 iliac, 65 infrainguinal), 9 (8.3%) had massive PE without evidence of lower limb DVT, and 1 (0.9%) had isolated IVC thrombosis. Forty-seven (43.1%) patients had PE before filter insertion. There were 2 serious procedure-related complications: one access site thrombosis and one right ventricular perforation. With a mean follow-up of 36 ± 33 months, no patient had further symptomatic PE or paradoxical embolism. There were a total of 54 (49.5%) deaths, with a 30-day mortality of 8.3%; none of them was device or procedure related. Among the 92 patients followed up, 27 (29.3%) had further VTE-either DVT in the index or the contralateral lower limb (20 patients, 21.7%), or thrombus inside the filter or the IVC (14 patients, 15.2%). Forty-one (44.6%) patients reported post-thrombotic syndrome (PTS) symptoms. Anticoagulant therapy was given to 39 (42.4%) and 55 (59.8%) patients in the periprocedural period and at any time during the study period, respectively. It did not reduce the rate of postfilter VTE or PTS in both instances. None of the filters in this series was retrieved. This observational study showed that IVC filters were effective in the prevention of PE, although symptomatic postfilter VTE and PTS were common, leading to significant morbidity. Patients who received permanent filters have high mortality on follow-up; however, none were procedure or device related.

Chow FC ，Chan YC ，Cheung GC ，Cheng SW ... -  《-》

Comprehensive assessment of prophylactic preoperative inferior vena cava filters for major spinal reconstruction in adults.

McClendon J Jr ，Oʼshaughnessy BA ，Smith TR ，Sugrue PA ，Halpin RJ ，Morasch M ，Koski T ，Ondra SL ... -  《-》

Indications, applications, and outcomes of inferior vena cava filters for venous thromboembolism in Japanese patients.

Yamashita Y ，Unoki T ，Takagi D ，Hamatani Y ，Ishii M ，Iguchi M ，Ogawa H ，Masunaga N ，Wada H ，Hasegawa K ，Abe M ，Akao M ... -  《-》

Prospective randomized study comparing the clinical outcomes between inferior vena cava Greenfield and TrapEase filters.

Although anticoagulation remains the mainstay of treatment for deep venous thrombosis, the use of inferior vena cava (IVC) filters when anticoagulation has failed or when contraindicated remains a safe and effective treatment. Greenfield (Boston Scientific, Natick, Mass) and TrapEase (Cordis, Bridgewater, NJ) filters are arguably among the most popular filtration devices. The Greenfield filter (12F introducer) has been in use for >30 years and has been well studied. The TrapEase filter (6F introducer) has been used since 2000, with a limited number of studies. Good guidelines to help determine which filter to use in any given situation are lacking; therefore, this randomized study prospectively compared the clinical outcomes (access-site thrombosis, filter thrombosis, and symptomatic pulmonary embolism [PE]) between these filters. Between July 2006 and November 2008, 156 patients (63 men, 93 women; mean age, 75 years; range, 38-101 years) were randomized: 84 to Greenfield and 72 to TrapEase IVC filter insertion in the infrarenal position using angiographic guidance. Postoperative follow-up comprised serial lower extremity and IVC/iliac vein (IV) duplex imaging (78.2%) at day 1, week 1, every 3 months for the first year, and every 6 months for the second year; clinical evaluation, and clinic visits. During this period, 349 patients (143 men, 206 women; mean age, 75 years; range, 24-96 years) were not randomized. The indications for filter placement, in the 156 randomized patients, were gastrointestinal bleeding, 37; intracranial hemorrhage, 12; free-floating clot, 19; failure of anticoagulation, 29; PE, 27; prophylactic, 4; and others, 32. During a mean 12-month follow-up (range, 0-39 months), symptomatic IVC/IV thrombosis developed in five patients (6.94%) in the TrapEase group and none in the Greenfield group (P = .019). No filter migration, access-site thrombosis, misplacement, or IVC perforation occurred. Recurrent PE was suspected in one of the five patients with IVC/IV thrombosis. Overall mortality was 42.3% (66 patients), and 30-day mortality was 13.5% (21 patients: 10 TrapEase, 11 Greenfield). The study was initially designed to recruit 360 patients in both TrapEase and Greenfield filters in 2 years to demonstrate any statistical significance but was prematurely concluded due to the interim results. A higher rate of symptomatic IVC/IV thrombosis is associated with TrapEase filter placement. However, the TrapEase filter still has a selective clinical role in the prevention of thromboembolism in selected patients who are coagulopathic. This is the first randomized prospective study comparing IVC filters since their inception in 1967.

Usoh F ，Hingorani A ，Ascher E ，Shiferson A ，Patel N ，Gopal K ，Marks N ，Jacob T ... -  《-》

Suprarenal inferior vena cava filters: a 20-year single-center experience.

Kalva SP ，Chlapoutaki C ，Wicky S ，Greenfield AJ ，Waltman AC ，Athanasoulis CA ... -  《JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY》