Early duplex scan evaluation of four vena caval interruption devices

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Transvenous inferior vena cava (IVC) filters are crucial for preventing pulmonary embolism (PE).
• Early thrombotic complications, including insertion site thrombosis (IST) and IVC thrombosis (IVCT), can occur post-placement.
• The incidence of these complications varies, especially with newer filter designs.

Purpose of the Study:

• To prospectively evaluate the incidence of IST and IVCT after placement of four different IVC filter types.
• To compare the rates of thrombotic complications among the birds' nest, titanium Greenfield, stainless steel Greenfield, and Simon nitinol filters.

Main Methods:

• 174 patients underwent percutaneous IVC filter placement over 21 months.
• Four filter types were used: birds' nest (22%), titanium Greenfield (39%), stainless steel Greenfield (25%), and Simon nitinol (14%).
• Color-flow venous duplex ultrasound was performed 7-10 days post-placement to assess for IST and IVCT.

Main Results:

• Early IST occurred in 24.7% of cases, and early IVCT in 12%.
• No significant difference in IST or IVCT rates was observed among the four filter types.
• IVCT incidence was higher in patients treated for PE; thrombotic complications were not linked to patient sex.

Conclusions:

• The observed incidence of thrombotic complications was higher than previously reported.
• None of the IVC filters evaluated demonstrated superior performance regarding thrombotic complications.
• Objective analysis of thrombotic complications is essential for selecting IVC devices during development or modification.