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Retrievable inferior vena cava filter utilization in obstetric patients
Amihai Rottenstreich1, Yosef Kalish2, Uriel Elchalal1
1a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
Summary
Retrievable inferior vena cava filters (rIVCF) in obstetric patients show frequent complications and removal failures. Cautious use is advised due to risks and radiation exposure, with outcomes yet to be fully established.
Area of Science:
- Medical Imaging and Interventional Radiology
- Obstetrics and Gynecology
- Vascular Surgery
Background:
- Inferior vena cava filters (IVCF) are used to prevent pulmonary embolism in high-risk patients.
- Retrievable IVCF (rIVCF) offer a temporary solution, but their use in obstetric patients is less understood.
- Obstetric patients present unique challenges due to physiological changes and potential risks to mother and fetus.
Purpose of the Study:
- To evaluate the utilization patterns of retrievable inferior vena cava filters (rIVCF) in pregnant and postpartum patients.
- To assess the clinical outcomes and complication rates associated with rIVCF placement in this specific population.
- To analyze the success rates of filter retrieval and identify factors influencing outcomes.
Main Methods:
- A single-center retrospective review of obstetric patients who underwent rIVCF placement between 2005 and 2016.
- A pooled analysis of existing English literature on rIVCF use in obstetric patients.
- Comparison of complication rates, retrieval success, and radiation exposure between different patient groups and procedures.
Main Results:
- In the study cohort (n=24), indications included withholding anticoagulation before delivery and adjunct therapy for thrombolysis.
- rIVCF-related complications occurred in 29.2% of patients, with successful retrieval in 90.5% of attempted cases (overall removal 79.1%).
- Literature review (n=98) showed similar complication and retrieval rates. Radiation dose was significantly lower in pregnant patients without adjunct catheter-directed thrombolysis.
Conclusions:
- High rates of rIVCF-related complications and retrieval failures necessitate cautious use in obstetric patients.
- Radiation exposure is a significant concern, particularly when combined with catheter-directed thrombolysis.
- The benefits of suprarenal placement and elective cesarean section for improving outcomes require further investigation.
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