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Inferior Vena Cava Filter Retrieval Rates Associated With Passive and Active Surveillance Strategies Adopted by
Emily Sterbis1, Jonathan Lindquist1, Alexandria Jensen2
1Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora.
Insights
Active surveillance by implanting physicians significantly increases inferior vena cava filter retrieval rates. This approach improves patient safety by ensuring timely device removal and reducing complications associated with permanent filters.
Area of Science:
- Vascular Surgery
- Medical Device Surveillance
- Patient Safety
Background:
- Inferior vena cava (IVC) filters are frequently implanted but rarely retrieved, leading to significant patient morbidity.
- Current guidelines recommend shared responsibility for IVC filter follow-up, but its effectiveness is unclear.
- Improved device surveillance is crucial to mitigate risks associated with non-retrieved IVC filters.
Purpose of the Study:
- To evaluate whether implanting physicians assuming primary responsibility for follow-up care increases IVC filter retrieval rates.
- To compare the outcomes of active versus passive surveillance strategies for IVC filter management.
Main Methods:
- Retrospective cohort study of 699 patients who received retrievable IVC filters from June 2011 to September 2019.
- Comparison of passive surveillance (mailings) with active surveillance (periodic assessment and scheduling by implanting physicians).
- Regression analysis to determine the association between surveillance method and filter nonretrieval, adjusting for patient demographics and clinical factors.
Main Results:
- Active surveillance was associated with a significant increase in IVC filter retrieval rates (61.3% vs. 48.7%, P < .001).
- Fewer filters were left in place permanently under active surveillance (1.6% vs. 12.2%, P < .001).
- Factors associated with increased odds of nonretrieval included older age at implantation, concomitant malignancy, and passive surveillance.
Conclusions:
- Active surveillance by implanting physicians significantly improves IVC filter retrieval.
- This study supports the adoption of active surveillance protocols where implanting physicians take primary responsibility for IVC filter tracking and retrieval.
- Proactive management by implanting teams enhances patient safety and reduces long-term complications.
Importance:
Inferior vena cava filters are commonly implanted and infrequently retrieved. Nonretrieval contributes to significant morbidity, motivating US Food and Drug Administration and multisociety communications emphasizing the need for improved device surveillance. Current guidelines suggest that implanting physicians and referring physicians should be responsible for device follow-up, but it is not known whether shared responsibility contributes to lower retrieval.
Objective:
To determine if primary responsibility for follow-up care assumed by the implanting physician team is associated with increased device retrieval.
Design, Setting, And Participants:
This retrospective cohort study examined a prospectively collected registry of patients with inferior vena cava filters implanted from June 2011 to September 2019. Medical record review and data analysis was completed in 2021. The study included 699 patients who underwent implantation of retrievable inferior vena cava filters at an academic quaternary care center.
Exposures:
Prior to 2016, implanting physicians had a passive surveillance strategy whereby letters highlighting indications for and the need for timely retrieval were mailed to patients and ordering clinicians. Starting in 2016, implanting physicians assumed active responsibility for surveillance, whereby candidacy for device retrieval was assessed periodically via phone calls and retrieval scheduled when appropriate.
Main Outcomes And Measures:
The main outcome was the odds of inferior vena cava filter nonretrieval. Within regression modeling of the association between the surveillance method and nonretrieval, additional covariates of patient demographics, concomitant malignant neoplasm, and presence of thromboembolic disease were included.
Results:
Of the 699 patients who received retrievable filter implants, 386 (55.2%) were followed up with passive surveillance, 313 (44.8%) with active surveillance, 346 (49.5%) were female, 100 (14.3%) were Black individuals, and 502 (71.8%) were White individuals. The mean (SD) age at filter implantation was 57.1 (16.0) years. Mean (SD) yearly filter retrieval increased following the adoption of active surveillance, from 190 of 386 (48.7%) to 192 of 313 (61.3%) (P < .001). Fewer filters were deemed permanent in the active group vs passive group (5 of 313 [1.6%] vs 47 of 386 [12.2%]; P < .001). Age at the time of implantation (OR, 1.02; 95% CI, 1.01-1.03), concomitant malignant neoplasm (OR, 2.18; 95% CI, 1.47-3.24), and passive contact method (OR, 1.70; 95% CI, 1.18-2.47) were associated with increased odds of filter nonretrieval.
Conclusions And Relevance:
The findings of this cohort study suggest that active surveillance by implanting physicians is associated with improved inferior vena cava filter retrieval. These findings support encouraging physicians who implant the filter to take primary responsibility for tracking and retrieval.
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