Multi-Institutional Review of Inferior Vena Cava Filter Use in Pediatric Patients

Children at risk for pulmonary embolism (PE) may be treated with inferior vena cava (IVC) filter insertion when anticoagulation is impossible or ineffective. The purpose of this multi-institutional retrospective review is to better understand the indications and technical and clinical outcomes related to IVC filter placement and removal in pediatric patients.

This study was open to all institutions that placed IVC filters in pediatric patients. Data collected included demographics, indications, procedural details of filter insertion and/or removal, and clinical follow-up. Univariate analysis was performed.

A total of 250 filters were placed in 242 pediatric patients (135 male) at 12 participating hospitals between October 1994 and June 2020. Thrombosis was present in 82.8% of patients, PE in 34.8%, and anticoagulation adverse events (AEs) or contraindications in 45.9%. Most filter insertions were technically successful (99.1%); 3.1% were associated with minor AEs, and 0.4% with moderate AEs. Breakthrough pulmonary embolism occurred in 1.4% following filter placement. Filter retrieval rate was 76%. Removal was technically successful in 88% of attempts and resulted in minor AEs in 1.1% and severe AEs in 6.5%. Minor, moderate, and severe device-associated AEs occurred in 8%, 1.6%, and 3.2% of filters, respectively. There was no correlation between age or weight and outcomes, including breakthrough PE, AEs, or mortality.

IVC filter insertion in pediatric patients is feasible and associated with a high retrieval rate.