Keywords:
Interventional vascular, Veins / Vena cava, Vascular, Catheter venography, Audit and standards, Filter insertions, Removal, Embolism / Thrombosis, Outcomes
Authors:
J.-Y. Kowa, B. Hawthorn, R. Das, M. Gonsalves, S. M. Ameli, L. Ratnam; London/UK
DOI:
10.1594/ecr2018/C-1813
Aims and objectives
Inferior vena cava (IVC) filters are deployed in patients who develop,
or are at high risk of developing,
acute venous thromboembolism (VTE) when anticoagulation is inappropriate or unsuccessful [1].
It is recommended practice to retrieve the filter as soon as practicable (Fig. 1) when the contraindication to anticoagulation is temporary,
or future risk of pulmonary embolus is acceptably low [2]. Failure to retrieve temporary filters can lead to long-term complications - for example,
thrombus developing within the filter (Fig. 2 and Fig. 3).
With increasing use of IVC filters,
a robust system of documenting and monitoring retrieval forms an integral part of service delivery.
At the authors' institution (tertiary trauma centre),
a standard report is issued to the patient's care team on the day of filter insertion.
This advises the team to review the clinical indication for ongoing filtration,
as the rate of retrieval diminishes over time.
Where possible,
a retrieval date is booked in at the time of filter insertion.
Finally, all filter insertions are recorded on a computer database; this can be cross-referenced with patient letters to aid filter traceability.
This study reviews the number of IVC filters inserted at our institution over 2.5 years,
in order to evaluate retrieval rates and propose new strategies to improve filter follow-up.