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[Inferior vena cava filters. Indications and results in 111 patients]
R Mertens1, F Valdés, A Krämer
1Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile.
Insights
Inferior vena cava filters safely prevent pulmonary embolism when anticoagulation fails or is contraindicated. This study shows filter insertion is a secure procedure with good long-term outcomes.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiology
Background:
- Anticoagulation is standard for deep vein thrombosis (DVT) and pulmonary embolism (PE).
- Inferior vena cava (IVC) filter insertion is indicated when anticoagulation is contraindicated or ineffective.
- IVC filters serve as a crucial intervention for PE prevention in select patients.
Purpose of the Study:
- To evaluate the outcomes of IVC filter insertions in 111 patients.
- To assess the safety and efficacy of IVC filters in preventing PE.
Main Methods:
- Retrospective review of 111 patients undergoing IVC filter insertion between 1983-1997.
- Analysis of indications, insertion techniques (cut-down vs. percutaneous), access sites, and patient follow-up.
- Evaluation of complications, mortality, and long-term survival rates.
Main Results:
- 111 patients received IVC filters for PE (with anticoagulation issues) or DVT (with contraindications).
- Percutaneous insertion (64 patients) replaced cut-down (47 patients) over time, with fewer failures.
- No insertion-related mortality or complications were observed; 5- and 10-year survival rates were 63% and 47% respectively.
Conclusions:
- IVC filter insertion is a safe and effective method for preventing PE.
- The procedure demonstrates favorable long-term outcomes and is a viable alternative when anticoagulation is not feasible.
Background:
Anticoagulation is the treatment of choice for deep vein thrombosis and pulmonary embolism. Occasionally this treatment is contraindicated or fails to prevent pulmonary embolism. In these patients, inferior cava vein interruption is indicated and filter insertion is the procedure commonly performed.
Aim:
To report the results of inferior cava vein filter insertions in 111 patients.
Patients And Methods:
A retrospective review of patients in whom inferior cava vein filters were inserted was performed.
Results:
During the period 1983-1997, filters were inserted in 111 patients (56 female) aged 15 to 93 years old. Indications were pulmonary embolism with contraindication or failure of anticoagulation therapy or poor respiratory function (58 patients), deep vein thrombosis and contraindication for anticoagulation (32 patients) and other indications in 20 patients. In 47 patients, treated before 1993, the insertion required a cut-down. Since then, a percutaneous approach was used in the remaining 64 cases. Three insertion attempts failed, all using cut-down. One of these patients died due to a massive pulmonary embolism. In 88% of the patients the jugular vein was the access site and in 10 patients, the filter was deliberately deployed above the renal veins. There was no mortality or complications. Patients were followed during a maximal period of 147 months and 27 died of unrelated disorders. Survival at 5 and 10 years was 63 and 47% respectively. Symptomatic inferior cava vein obstruction was detected in 5 patients during the follow up period.
Conclusions:
Inferior cava vein filter insertion is a safe measure to prevent pulmonary embolism and its consequences.