Practice Patterns and Outcomes of Retrievable Vena Cava Filters in Trauma Patients: An AAST Multicenter Study
Document Type
Article
Publication Date
1-1-2007
Description
BACKGROUND: The purpose of this study is to describe practice patterns and outcomes of posttraumatic retrievable inferior vena caval filters (R-IVCF). METHODS: A retrospective review of R-IVCFs placed during 2004 at 21 participating centers with follow up to July 1, 2005 was performed. Primary outcomes included major complications (migration, pulmonary embolism [PE], and symptomatic caval occlusion) and reasons for failure to retrieve. RESULTS: Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% for prophylactic indications and 79% were placed by interventional radiology. Excluding 33 deaths, 152 were Gunter-Tulip (G-T), 224 Recovery (R), and 37 Optease (Opt). Placement occurred 6 ± 8 days after admission and retrieval at 50 ± 61 days. Follow up after discharge (5.7 ± 4.3 months) was reported in 51%. Only 22% of R-IVCFs were retrieved. Of 115 patients in whom retrieval was attempted, retrieval failed as a result of technical issues in 15 patients (10% of G-T, 14% of R, 27% of Opt) and because of significant residual thrombus within the filter in 10 patients (6% of G-T, 4% of R, 46% Opt). The primary reason R-IVCFs were not removed was because of loss to follow up (31%), which was sixfold higher (6% to 44%, p = 0.001) when the service placing the R-IVCF was not directly responsible for follow up. Complications did not correlate with mechanism, injury severity, service placing the R-IVCF, trauma volume, use of anticoagulation, age, or sex. Three cases of migration were recorded (all among R, 1.3%), two breakthrough PE (G-T 0.6% and R 0.4%) and six symptomatic caval occlusions (G-T 0, R 1%, Opt 11%) (p < 0.05 Opt versus both G-T and R). CONCLUSION: Most R-IVCFs are not retrieved. The service placing the R-IVCF should be responsible for follow up. The Optease was associated with the greatest incidence of residual thrombus and symptomatic caval occlusion. The practice patterns of R-IVCF placement and retrieval should be re-examined. © 2007 Lippincott Williams & Wilkins, Inc.
Citation Information
Karmy-Jones, Riyad; Jurkovich, Gregory J.; Velmahos, George C.; Burdick, Thomas; Spaniolas, Konstantinos; Todd, Samuel R.; McNally, Michael; Jacoby, Robert C.; Link, Daniel; Janczyk, Randy J.; Ivascu, Felicia A.; McCann, Michael; Obeid, Farouck; Hoff, William S.; McQuay, Nathaniel; Tieu, Brandon H.; Schreiber, Martin A.; Nirula, Ram; Brasel, Karen; Dunn, Julie A.; Gambrell, Debbie; Huckfeldt, Roger; Harper, Jayna; Schaffer, Kathryn B.; Tominaga, Gail T.; Vinces, Fausto Y.; Sperling, David; and Hoyt, David. 2007. Practice Patterns and Outcomes of Retrievable Vena Cava Filters in Trauma Patients: An AAST Multicenter Study. Journal of Trauma - Injury, Infection and Critical Care. Vol.62(1). 17-24. https://doi.org/10.1097/TA.0b013e31802dd72a PMID: 17215729 ISSN: 0022-5282