Comprehensive Overview of Inferior Vena Cava Filters: Indications, History, and Safety

Comprehensive Overview of Inferior Vena Cava Filters: Indications, History, and Safety

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  Who Really Needsan Inferior Vena Cava Filter N 2025 KHALID RAJHI MD FACS Consultant of Vascular and Endovascular Surgery Jazan Specialist Hospital , Jazan Health Cluster Lead of vascular Surgery, Jazan Province - Saudi Arabia
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  Inferior Vena Cava (IVC)Filter • a small metal device implanted in the inferior vena cava. • Prevent large blood clots floating to pulmonary arteries, PE.
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  1930s • IVC plicationor ligation. Marron Rm, et.al. Inferior vena cava filters: past, present, and future. Chest2020;158(06):2579– 2589
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  Who Needs anIVC Filter • Since the 1960s, IVC filter placement has been an important therapeutic option for patients with VTE in whom anticoagulation is contraindicated. • Over the decades, the use of IVCFs expanded to different patient populations including : - Patients with VTE who developed complications from anticoagulation. - Patients with recurrent VTE despite the use of anticoagulation.
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  • The firstIVCFs were designed to be permanent, later generation retrievable or optional filter designs allowed for percutaneous filter retrieval at a medically appropriate time. Schematic diagram of inferior vena cava filter models. A Permanent filters. B Retrievable filters
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  1940s Anticoagulation has beenthe preferred treatment for VTE since the 1940s.1 1967 In 1967, Dr. Kazi Mobin-Uddin developed the first endovascular IVCF.2 (Migration &Thrombosis) significant IVC pressure gradient 1973 In 1973, the Greenfield filter (Boston Scientific, Marlborough, MA), This filter was initially inserted via a venotomy. 1984 The first percutaneously placed Greenfield filter was reported in 1984.3 1- Cundiff DK et.al. Anticoagulation therapy for venous thromboembolism. MedGenMed 2004;6(03):5 3- Tadavarthy SM, et al. Kimray-Greenfield vena cava filter: percutaneous introduction. Radiology 1984;151(02):525–526 2- Kinney TB. Update on inferior vena cava filters. J Vasc Interv Radiol 2003;14(04):425–440
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  INDICATIONS of IVCFilter • Failure of anticoagulation Patient has a new clot despite an effective dose of anticoagulation • Absolute contraindication to anticoagulation Patients who have a life-threatening bleed while on anticoagulation and cannot safely resume them • Interruption of anticoagulation IVC filter may be temporarily placed in patients who need to stop anticoagulant for major surgery or an invasive procedure
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  Important considerations • Exclusionof modifiable factors Before placing a filter, such as poor adherence, drug interactions, or incorrect dosing. • Risk-benefit analysis The risk of a filter-related complication should be weighed against the risk of further clots. • Removal A temporary filter, such as for surgery, it should be removed as soon as it is safe to restart anticoagulation, as prolonged use increases the risk of complications. • Underlying conditions Hypercoagulable conditions should be excluded before placing a filter, as this could lead to significant morbidity
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  FDA safety communication (2014) •FDA recommended removal of the IVC filter within 2 months after filter placement if the patient's risk of thrombosis had passed
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  Complications of IVCFilter • Filter migration • Perforation • Filter fracture • Infection • Blood clotting Altered flow dynamics / Device related factors. • Retrieval complications
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  SAFE-IVC study 01 January2013 – 31December 2021 • Aim : understand contemporary IVC filter use and outcomes • A total of 270,866 patients • Most patients (64.9%) received IVC filters for first-time venous thromboembolism (VTE), 26.3% for recurrent VTE, and 8.8% for VTE prophylaxis • IVC filter use declined from 44,680 annually in 2013 to 19,501 in 2021. • The cumulative incidence of IVC filter retrieval was approximately 15%, with most retrievals occurring within the first-year post insertion. • Older age, more comorbidities and low income were associated with a lower likelihood of retrieval. • The success rate of IVC filter retrieval was 93.5% with a 3.9% cumulative incidence of 30-day complications. Ferro, et al. Postmarketing surveillance of inferior vena cava filters among US Medicare beneficiaries. JAMA. 2024
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  Who Really Needsan IVC Filter N 2025 • Even today, according to international guidelines, the use of IVC filters is controversial. • In most cases, individualized patient assessment is appropriate.
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  • Apart fromthe well-established indication for IVC filter placement represented by contraindication to anticoagulants during an acute event of VTE, • Other potential indications should be evaluated on a case-by-case basis by experienced clinicians.