Inferior vena caval filter use in U.S. trauma centers: a practitioner survey

Questionnaires were mailed to 620 U.S. "trauma surgeons" to determine a consensus regarding indications for inferior vena caval (IVC) filter placement; 210 (34%) responded. Eighty-seven percent of respondents practiced in Level I trauma centers; 78% were in urban areas and 75% reported more than 1,000 trauma admissions per year. One-half (52%) of those responding were "trauma directors" at their centers. Filter insertion was done by radiologists at 81% of centers, by trauma surgeons at 34%, by vascular surgeons at 33%, and by general surgeons at 13%. Each month, 60% of trauma centers inserted zero or one filter, whereas 27% inserted two to three filters. Complications per year were reported as one or fewer in 85% of trauma centers. Respondents agreed that "absolute indications" for inserting IVC filters were pulmonary embolism while anticoagulated (93%), deep venous thrombosis present and anticoagulation contraindicated (89%), and free-floating ileofemoral thrombus by venogram (54%) and by duplex imaging (45%). "Relative indications" for placement were deep venous thrombosis by duplex imaging (41%) or by venogram (38%), spinal cord injury (40%), pelvic fractures (39%), multiple lower-extremity fractures (29%), concurrent cancer (19%), prolonged bed rest (14%), and obesity (10%). The permanent nature of the filter affected its rate of application. For example, potential removability would significantly (p < 0.01) increase prophylactic placement from 29 to 53% in the patient with multiple lower-extremity fractures. Only 12% considered sepsis and 10% young age as contraindications to IVC filter insertion. Contraindications and complications were few, yet frequency of use was surprisingly low. Radiologists insert the filter more than twice as often as surgeons.