Indications and appropriateness of inferior vena cava filter placement

Several professional societies have published guidelines for the placement of inferior vena cava (IVC) filters. The authors wanted to determine how frequently patients in their hospital had IVC filters placed based on current indications and to compare guidelines published by the American College of Chest Physicians (ACCP) and the Society of Interventional Radiologists (SIR).

The authors performed a structured review of the medical records of 180 patients identified by International Classification of Diseases, Ninth Revision, codes who had IVC filter placement at their hospital between July 1, 2007, and June 30, 2012. Indications for placement were based on current recommendations from the ACCP and SIR.

These patients had a mean age of 62.4 ± 15.7 years and included 96 men and 84 women. One hundred forty patients had a history of deep venous thrombosis, pulmonary emboli or both. One hundred seven patients had permanent filters inserted, 34 had retrievable filters inserted and 39 had an unknown type of filter inserted. Forty-one patients (22.7%) had no definite indication for IVC filter insertion based on SIR guidelines, and 72 (40%) had no definite indication based on ACCP guidelines. There was a good agreement between the ACCP guidelines and the SIR guidelines when indications were categorized. Only one retrievable filter was removed.

Twenty to forty percent of the patients with IVC filter insertions in their hospital had no definite indication documented in the medical record. A performance improvement activity to evaluate the use of IVC filters, such as a dedicated clinic, may be useful.