Aims and objectives
Introduction:
Prior to the invention of the first endovascular inferior vena cava filter by Mobin-Uddin in 1967 [1],
therapeutic interruption of the IVC was achieved through open surgery in which the vessel was variously plicated with sutures [2] or clamped externally [3].
Today,
retrievable filters,
which have been available since the early 2000’s [4],
are typically deployed when a temporary contraindication to anticoagulation exists and removed once the patient is again suitable for anticoagulation.
A common clinical scenario in whichtemporary IVC filter placement is required...
Methods and materials
Patients:
Cases were identified using a prospectively maintained database of all patients undergoing IVC filter placement at a university teaching hospital.
All cases of IVC filter placement from May 2011 to May 2017 were identified and those cases in which the filter was placed preoperatively were then selected for analysis.
The following data was then extracted from thedatabase for each case; patient demographics; technique of filter insertion; type of surgery undertaken; duration of retrieval procedure; retrieval success or failure; any decision to leave filter in...
Results
230 IVC filters were placed during the study period.
Of these,
66 insertions were performed preoperatively in 65 patients due to perioperative contraindications to anticoagulation,
generating 71 attempts at filter retrieval (Image 1: Indications for filter insertion.)
19.7% (n=13) were explicitly not retrieved due to life limiting conditions,
4.5% (n=3) were not retrieved following a consensus decision that the patient would never be fit for oral anticoagulation.
Of the 50 cases where retrieval was desired,
90% (n=45) were successful on first attempt.
The remaining 10%...
Conclusion
96 Normal 0 false false false EN-US X-NONE X-NONE
In this single-institution case series,
failure to retrieve preoperatively-inserted IVC filters occurred in two subgroups: patients who developed perioperative DVTs with ileocaval extent,
and those in whomsurgical instrumentation of the retroperitoneum was a feature.
Surgeons,
when operating on patients with an in situIVC filter,
should be conscious of the risk of displacing or disturbing the filter when instrumenting the retroperitoneum.
References
1.Mobin-Uddin K,
Smith PE,
Martinez LO,
Lombardo CR,
Jude JR.
A vena caval filter for the prevention of pulmonary embolus.
Surg Forum 1967; 18: 209–11
2.DeWeese,
MS and Hunter,
DC Jr.
A vena cava filter for the prevention of pulmonary emboli.
Bull Soc Int Chirurgie.
1958; 1: 1–9
3.Moretz,
WH,
Rhode,
CM,
and Shephard,
MH.
Prevention of pulmonary emboli by partial occlusion of the inferior vena cava.
Am Surg.
1959; 25: 617–623
4.
Kaufman,
John A.
et al.Guidelines for the Use of Retrievable and Convertible...