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Current Controversies in Inferior Vena Cava Filter Placement: AJR Expert Panel Narrative Review.

Andrew Kesselman1, Thein Hlaing Oo2, Matthew Johnson3

  • 1Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E 68th St, Payson Pavilion 501, New York, NY 10065.

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Summary

Inferior vena cava (IVC) filters benefit high-risk patients during interventions. Selective use, timely retrieval, and appropriate anticoagulation are crucial for optimal IVC filter management and patient outcomes.

Keywords:
IVCfilter retrievalinferior vena cava filtervenous thromboembolism

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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Cardiovascular Medicine

Background:

  • Inferior vena cava (IVC) filters have been used for over 50 years.
  • Controversies persist regarding optimal IVC filter utilization and management.
  • Current practices require evidence-based guidance for improved patient care.

Purpose of the Study:

  • To review recent literature on IVC filter practices.
  • To provide expert opinions on the appropriate use and management of IVC filters.
  • To guide clinical practice, innovation, and research in IVC filtration.

Main Methods:

  • Literature review of recent studies on IVC filter use.
  • Synthesis of expert opinions on filter indications, retrieval, and anticoagulation.
  • Analysis of complications and management strategies for IVC filters.

Main Results:

  • IVC filtration is most beneficial for patients at high risk of iatrogenic pulmonary embolism during endovenous interventions.
  • Selective use in trauma and bariatric surgery patients is recommended.
  • Filter retrieval should be attempted for perforating or fractured filters with favorable risk-benefit ratios; antibiotic prophylaxis is advised for GI penetration.
  • Anticoagulation is not recommended solely for filter presence unless malignancy is active; it may reduce long-term complications in these patients.
  • Symptomatic IVC occlusion warrants consideration for filter removal and IVC reconstruction.
  • Physician-patient relationships and scheduled follow-up maximize retrieval rates.
  • Advanced retrieval techniques improve success but require caution and potential referral to specialized centers.

Conclusions:

  • Optimizing IVC filter utilization requires selective application, timely and feasible retrieval, and judicious anticoagulation strategies.
  • Proactive patient follow-up and advanced retrieval techniques are essential for managing filter-related complications.
  • Further research and adherence to evidence-based guidelines are needed to refine IVC filter practices.