Inferior vena cava filters in children: our experience and suggested guidelines

Although use of inferior vena cava (IVC) filters for prophylaxis against pulmonary embolism (PE) is well reported in adults, long-term studies in children are lacking. We performed retrospective review of imaging and clinical database of IVC filters for the last 12 years. Thirty-five patients (mean age: 15.5 y) underwent filter placement and/or retrieval. Indications for placement were contraindication to anticoagulation with known deep venous thrombosis (DVT) (18) or high risk of venous thromboembolism (5), recurrent DVT despite anticoagulation (1), and prophylaxis before endovascular thrombolysis (8). All filter placements were technically successful without any complications. Filter retrieval was successful in 15 of 19 attempted (79%) at a mean of 42 days. Two complications occurred during retrieval: IVC stenosis successfully treated with angioplasty and contained IVC perforation. Endothelialization of filter prevented retrieval in 4 patients. Mean follow-up was 29.3 months. No patients had IVC thrombosis, breakthrough pulmonary embolism, filter fracture, or embolism. Two patients had recurrent DVT. Our results indicate that IVC filters can be successfully placed and retrieved in children with minimal procedural complications; follow-up demonstrates acceptable complication rate owing to presence of filters. Prophylactic IVC filter placement may be considered before endovascular thrombolysis for lower extremity DVT. Retrievable filters should be used in children for appropriate indications.