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Inferior vena cava (IVC) filters in children: A 10-year single center experience
Amihai Rottenstreich1, Shoshana Revel-Vilk2, Allan I Bloom3
1Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Insights
Inferior vena cava (IVC) filters in children have limited evidence for prophylactic use, with low retrieval rates and high complication risks. Dedicated follow-up is crucial for pediatric VTE management.
Area of Science:
- Pediatric cardiology and hematology
- Vascular interventions and thrombosis management
Background:
- Venous thromboembolism (VTE) is a growing concern in pediatric populations.
- Limited data exist on the safety and efficacy of inferior vena cava (IVC) filter placement in children for pulmonary embolism prevention.
Purpose of the Study:
- To evaluate the safety and efficacy of IVC filter placement in pediatric patients.
- To assess the appropriateness of filter referral for retrieval and analyze retrieval rates and complications.
Main Methods:
- Retrospective review of medical records for children and adolescents undergoing IVC filter insertion at a university hospital.
- Assessment of prophylactic versus therapeutic indications for filter placement.
- Evaluation of filter retrieval rates, attempts at removal, and filter-related complications.
Main Results:
- Fifty-nine pediatric patients (mean age 16) received retrievable IVC filters, primarily for prophylactic reasons (79.7%) in trauma settings.
- Successful filter retrieval occurred in only 20.3% of cases, despite appropriate conditions for removal in over 90%.
- A 17% rate of filter-related complications was observed, with higher retrieval rates in patients managed at a thrombosis clinic.
Conclusions:
- The prophylactic use of IVC filters in children lacks strong supporting evidence and is associated with a low retrieval rate and high complication incidence.
- The widespread use of IVC filters in pediatric patients warrants careful consideration due to these findings.
- Close follow-up is essential for monitoring complications and facilitating timely filter retrieval when indicated.
Background:
Venous thromboembolism (VTE) is an increasingly recognized problem among children and adolescents. Although inferior vena cava (IVC) filter placement for pulmonary embolism prevention is well reported in adults, data regarding safety and efficacy in the pediatric age group are lacking.
Procedure:
At a large university hospital with a level I trauma center, medical records of children and adolescents who underwent IVC filter insertion were reviewed. Appropriateness of referral for retrieval was assessed in each case.
Results:
Fifty-nine children and adolescents (mean age 16 years) successfully underwent IVC filter insertion. All filters placed were retrievable. In 47 patients (79.7%), prophylactic filters were placed in the absence of acute VTE in the setting of trauma. In eight patients (13.5%), filters were placed due to contraindication to anticoagulation therapy with concomitant lower extremity deep vein thrombosis or pulmonary embolism. Filters were successfully retrieved in only 12 patients (20.3%), although an attempt at removal was appropriate and feasible in over 90% of cases. Mean duration of follow-up was 2.1 (range 0.4-7.3) years. A significantly higher retrieval rate was found in patients followed at our thrombosis clinic (P < 0.01). Ten patients (17%) experienced at least one filter-related complication.
Conclusions:
Although in most cases, IVC filters were placed for prophylactic indications, the evidence to support their role in this setting is limited. Their low retrieval rate and high filter-related complication rate question their extensive utilization in children. Dedicated follow-up is necessary to detect complications and to ensure that an attempt at retrieval is made when feasible.
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