Vena caval filters

The patient with a caval filter poses a challenge to the emergency physician. Key considerations in management are a knowledge of underlying disease processes in this patient population, indications for filter placement, potential early or delayed complications associated with these devices, and appropriate diagnostics and consultation. Diagnostic evaluation should include plain radiographs to evaluate gross structural problems, filter migration, significant filter tilting or angulation, and filter leg span splaying or retraction as well as evidence of visceral perforation or obstruction. Comparison films should be obtained, if possible. Screening laboratory tests to assess coagulation, hematologic, and renal function are indicated. The possibility of recurrent PE and a reassessment of filter protection and anticoagulation status should be considered. Advanced diagnostic imaging tools such as abdominal CT, duplex sonography, and cavography may be needed to elucidate suspected caval filter complications, or suspected new DVT or IVC occlusion. Early consultation is indicated. With new and expanded indications as well as technical improvements in caval filters, increased use of these devices can be anticipated, as can associated complications first seen and evaluated by the emergency medicine physician.