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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Cardiovascular Medicine

Background:

  • Current guidelines recommend retrievable inferior vena cava filters (RIVCF) before endovascular intervention (EI) for deep vein thrombosis (DVT).
  • The impact of EI on RIVCF-related thrombosis/trapped embolus (T/TE) remains controversial.

Purpose of the Study:

  • To evaluate the effect of endovascular intervention (EI) on the incidence of RIVCF-related thrombosis/trapped embolus (T/TE).
  • To assess the necessity of routine RIVCF placement prior to EI for DVT.

Main Methods:

  • Prospective registry-based study of 2,773 patients undergoing RIVCF placement across 103 Chinese centers (2018-2019).
  • Patients stratified into EI (n=1,472) and no-EI (n=1,301) groups, propensity-score matched (1:1) to balance baseline variables.
  • Primary endpoint: RIVCF T/TE, validated by core-lab adjudicated imaging (CT/angiography).

Main Results:

  • After matching (n=1,007 per group), EI was associated with a 46% lower risk of RIVCF T/TE (8.9% vs. 14.0%, P<0.001).
  • Symptomatic pulmonary embolism rates were comparable between groups (1.2% vs. 2.8%, P=0.07).
  • No significant brand-specific differences in T/TE incidence were observed (P=0.32).

Conclusions:

  • Endovascular intervention (EI) reduces the risk of RIVCF-related thrombosis/trapped embolus (T/TE).
  • Routine RIVCF placement prior to EI may not be necessary for all DVT patients.
  • Selective filter use could potentially spare patients from device-related complications.