Inferior vena cava filters in malignant disease

Patients undergoing treatment for cancer have a high risk and prevalence of venous thrombosis and frequent contraindications to anticoagulation therapy that lead to placement of caval filters. We questioned whether the increasing frequency of this intervention has clinical benefit.

Between 1993 and 2000, 116 patients undergoing active treatment for malignant disease underwent filter placement at our institution. Outcome was retrospectively assessed with regard to procedural complications, recurrent thrombotic events, and patient survival.

Primary tumors were gastrointestinal (n = 25), lung (n = 24), breast (n = 14), gynecologic (n = 14), prostate (n = 12), hematologic (n = 8), urologic (n = 4) or other (n = 15). Indications for filter were contraindication to anticoagulation therapy for deep venous thrombosis (DVT) or pulmonary embolism (PE; bleeding, n = 33; surgery, n = 29), recurrent or propagating DVT or recurrent PE during anticoagulation therapy (n = 17), right heart failure (n = 15), intracerebral malignancy (n = 7), and other indications (n = 18). Procedural complications were five localized hematomas, none necessitating surgery. Two patients had progressive DVT and three had clinical recurrent PE after filter placement. Life-table analysis revealed survival rates of 68.8% at 30 days, 49.4% at 3 months, and 26.8% at 1 year (standard error, <5%). Of 91 patients with stage IV disease, 42 patients had died of cancer within 6 weeks and only 13.7% were alive at 1 year.

Although recurrent thromboembolic events are rare after caval filter placement in patients with malignant disease, survival is short in most patients with stage IV disease and prevention of PE may be of little clinical benefit and a poor utilization of resources. Oncologists should consider these sobering results when requesting filter placement in patients with advanced malignant disease.