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When to implant a caval filter?

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Pelouze Guy-André
Pelouze Guy-André
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When to implant a permanent or retrievable filter in the vena cava? Quand poser un filtre cave temporaire ou définitif? Dr Guy-André Pelouze Chirurgien thoracique & cardiovasculaire Perpignan Conflict of interest: None declared January 27th 2012 Société Française d’Angéiologie
Is DVT a benign disease?
Rudolf Ludwig Karl Virchow (1821-1902) ,[object Object]
How PE occurs? ,[object Object],[object Object],[object Object]
Present Pulmonary embolism prevalence and mortality ,[object Object],[object Object],[object Object]
Caval interruption Devices ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Numerous publications and only 2 RCTs !
 
Rational of filter placement ,[object Object],[object Object],[object Object]
Technique ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of permanent caval filters ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Complications of IVCF (1):Thrombosis
Complications of IVCF (2):Thrombosis
 
Aortic pseudoaneurism due to perforation of the two walls by a VCF
Potential indications of filter placement ,[object Object],[object Object],[object Object],[object Object]
 
 
Methodological quality summary: review authors’ judgements about each methodological quality
PREPIC 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NEJM
Results (1) Référence
Kaplan-Meier analysis of time to pulmonary embolism
Kaplan-Meier analysis of time to deep vein thrombosis
Kaplan Meyer analysis of survival
Cochrane data base review (2010) ,[object Object],[object Object]
Future of caval interruption (1): Retrievable Filters ,[object Object],[object Object],[object Object],[object Object]
Future of caval interruption (2a): New devices with new design and better synergy of prevention
Future of caval interruption (2b): New devices with new design and better synergy of prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Future of caval interruption (3): new RCT(s)
PREPIC 2 study ,[object Object],[object Object],[object Object],[object Object]
If you decide to implant a filter which is the best ?
PE prevention
DVT after placement
VC Thrombosis after placement
The trauma patient
Cohort studies reporting PE in trauma patients (observational studies)
Cohort studies reporting DVT (observational studies)
Indications for IVC filter placement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Conclusion (1): non trauma patients Risk: Overtreatment because of overdiagnosis and fear of PE in recent era? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusion (2): trauma patients Risk: underutilisation because of rare indications or overuse in large prophylactic indications ,[object Object]
If you have understood the problem of caval filters would you like to share it?
 
Look at my preferred social network!
Merci de votre attention [email_address]

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