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Retrievable Inferior Vena Cava Filter Trapped Embolus: A Risk Factor of Detachment of Thrombus Analysis Based on a
Lei Zhang1, Wen-Ping Hu1,2, Hao Zhang1
1Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China.
Summary
Inferior vena cava filters may cause trapped embolus in patients with lower limb fractures or pelvic surgery. Filter placement is not always necessary, especially in elderly patients or those receiving catheter-directed thrombolysis only.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Pulmonary Embolism Prevention
Background:
- Indications for inferior vena cava filter (IVCF) placement remain debated.
- Thrombus detachment and pulmonary embolism are significant risks.
Purpose of the Study:
- Identify risk factors for thrombus detachment.
- Evaluate the necessity of IVCF placement to prevent fatal pulmonary embolism.
Main Methods:
- Multicenter prospective observational study of 2892 patients undergoing retrievable IVCF (RIVCF) placement.
- Primary endpoint: RIVCF trapped embolus detected via imaging or macroscopic thrombus.
- Analysis of factors associated with RIVCF trapped embolus.
Main Results:
- 10.65% of patients developed RIVCF trapped embolus.
- Higher incidence in patients with below-knee/thigh fractures, pelvic surgery, and percutaneous mechanical thrombectomy + catheter-directed thrombolysis (PMT+CDT).
- Lower incidence in older patients and those receiving CDT alone.
Conclusions:
- Lower limb fractures, pelvic surgery, and PMT+CDT are risk factors for trapped embolus, indicating potential for fatal pulmonary embolism.
- IVCF placement may not be necessary for elderly patients or those treated with CDT alone.
- Standardizing IVCF use and focusing on high-risk groups is crucial.
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