Related Experiment Video
Updated: Mar 24, 2026
Author Spotlight: Utilizing Venoplasty Balloon Model in Rodents to Simulate Surgical Interventions for Deep Veins
Published on: May 24, 2024
Inferior vena cava filter placement during thrombolysis for acute iliofemoral deep venous thrombosis
Efthymios D Avgerinos1, Eric S Hager1, Geetha Jeyabalan1
1Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Insights
Inferior vena cava (IVC) filters may be selectively used during thrombolysis for iliofemoral deep venous thrombosis (DVT). Female gender and preoperative pulmonary embolism (PE) are risk factors for embolization, guiding selective IVC filter use.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Acute iliofemoral deep venous thrombosis (DVT) poses a risk of pulmonary embolism (PE).
- Thrombolysis is a treatment option for iliofemoral DVT, but embolization risk exists.
- The role of inferior vena cava (IVC) filters during thrombolysis for DVT requires clarification.
Purpose of the Study:
- To assess the necessity of IVC filters during thrombolysis for acute iliofemoral DVT.
- To identify patient-specific and anatomic risk factors for embolization during these procedures.
Main Methods:
- A retrospective analysis of patients undergoing thrombolysis (catheter-directed or pharmacomechanical) for iliofemoral DVT.
- Patients were grouped based on IVC filter use (filter protection vs. no filter).
- Primary outcome: perioperative clinically significant PE or intraprocedural IVC filter clot capture.
Main Results:
- No clinically significant PE occurred in either group.
- Embolic clot within the filter occurred in 22% of patients with filters; clinically significant clot in 5%.
- Female gender (OR 5.833) and preoperative PE (OR 5.6) were significant risk factors for embolization.
Conclusions:
- IVC filters should be selectively employed in patients with preoperative PE and in women.
- Consideration for IVC filter use in patients with multiple DVT risk factors or undergoing stand-alone pharmacomechanical thrombolysis.
- Selective IVC filter use can optimize treatment for iliofemoral DVT while managing embolization risks.
Objective:
The objectives of this study were to evaluate the need for inferior vena cava (IVC) filters and to identify anatomic and patient-specific risk factors associated with embolization in patients undergoing thrombolysis for acute iliofemoral deep venous thrombosis (DVT).
Methods:
Consecutive patients who underwent catheter-directed thrombolysis or pharmacomechanical thrombolysis (PMT) for iliofemoral DVT from May 2007 to March 2012 were identified from a prospectively maintained database. Patients were categorized in two groups, depending on the status of IVC filtration during the lysis procedures: patients with an IVC filter protection (group A) and patients without an IVC filter protection (group B). The primary outcome was perioperative clinically significant pulmonary embolism (PE) or intraprocedural IVC filter clot capture.
Results:
Eighty patients (mean age, 50 ± 16 years; 39 women) with symptoms averaging 12 ± 10 days were treated. A perioperative IVC filter was placed in 32 patients, and nine patients had an indwelling patent filter (group A, n = 41). Twenty patients received no filter, and 19 patients had an indwelling thrombosed filter (group B, n = 39). There were no clinically significant PE in either group. In group A, nine patients (22%) had documented embolic clot within the filter nest. The clot volume was deemed clinically significant in only two patients (5%). Factors related to embolization included female gender (odds ratio [OR], 5.833; 95% confidence interval [CI], 1.038-32.797; P = .032) and preoperative clinical PE (OR, 5.6; 95% CI, 1.043-30.081; P = .054). A trend for increased embolization was seen with a higher average number of DVT risk factors (1.44 vs 1; P = .065) and when PMT was used as a single treatment (OR, 4.32; 95% CI, 0.851-21.929; P = .087).
Conclusions:
IVC filters during thrombolysis should be used selectively in patients with preoperative clinical PE, in women and potentially in patients with multiple risk factors for DVT, or when stand-alone PMT is planned.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:30Venous Thrombosis I: Introduction
01:25Hemodialysis I: Introduction
01:18Veins of the Abdomen and Pelvis
The inferior vena cava is fed by numerous smaller veins. The lumbar veins, for instance, drain the posterior abdominal wall, emptying both directly into the inferior vena cava and into the...