Inferior Vena Cava Filter

Excerpt

Pulmonary embolism (PE) secondary to venous thromboembolism (VTE) is a major preventable cause of mortality in hospitalized patients. Prophylactic anticoagulation with mechanical and pharmacological therapies is indicated for high-risk patients. Pharmacological anticoagulation is the first-line treatment for newly diagnosed VTE and pulmonary embolism. Inferior vena cava (IVC) filter is a treatment option to prevent pulmonary embolism in a select group of patients that have venous thromboembolism (VTE) and absolute contraindication to anticoagulation, failure of anticoagulation, complications resulting from anticoagulation or progression of deep vein thrombosis (DVT) despite adequate anticoagulation.

The Greenfield inferior vena cava filter came on the market in 1973. Currently, there are two categories of IVC filters in use: permanent and retrievable. The use of IVC filters has increased since the advent of retrievable IVC filters that were approved by the FDA in 2003 and 2004.

Most studies have not shown any difference in the all-cause mortality in deep venous thrombosis (DVT) patients treated with IVC filters compared to the ones treated with anticoagulation therapy alone. Prophylactic IVC filters are sometimes inserted in patients at high risk of developing venous thromboembolism (VTE), especially if there is a contraindication to anticoagulation. These studies have not shown any mortality benefit. In fact, IVC filters correlate with an increased risk of recurrent deep vein thrombosis and other complications.