Inferior Vena Cava Filter Retrieval Trends: A Single-Center Experience

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Device Safety

Background:

• Inferior vena cava filters (VCFs) are used to prevent pulmonary embolism.
• FDA safety warnings (2010, 2014) recommended VCF removal after the risk of pulmonary embolism has decreased.
• Despite warnings, VCF retrieval rates have remained suboptimal.

Purpose of the Study:

• To investigate trends in retrievable VCF retrieval rates in adults.
• To identify factors influencing VCF retrieval after placement between 2015 and 2018.
• To assess the impact of anticoagulation status on VCF retrieval.

Main Methods:

• Retrospective analysis of 494 VCF placements (305 retrievable) at a single institution.
• Calculation of cumulative incidence of retrieval, accounting for the competing risk of death.
• Statistical analysis to identify predictors of VCF retrieval and non-retrieval.

Main Results:

• The cumulative incidence of VCF retrieval remained low at 21% at 1 year, even after the 2014 FDA warning.
• Patients who resumed anticoagulation (AC) were significantly more likely to have their VCF retrieved (HR=3.6, p<0.01).
• Advanced age, history of stroke, and active malignancy were associated with lower VCF retrieval rates.

Conclusions:

• VCF retrieval rates continue to be low, indicating a need for improved management strategies.
• Resumption of anticoagulation is a key factor associated with successful VCF retrieval.
• Current guidelines may need revision to include active surveillance for anticoagulation tolerance to enhance VCF removal rates.