Inferior Vena Cava Filters: Two Years Experience in King Abdulaziz University Hospital (original) (raw)
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Inferior Vena Cava Filters: Two Years Experience in
2016
Abstract. Pulmonary embolism remains a serious challenge for health care. Anticoagulation is considered the first line of treatment; however, in patients with anticoagulation failure or contraindication, inferior vena cava filter placement has been widely performed for the prevention of pulmonary embolism. This study is a retrospective review of King Abdulaziz University Hospital two years experience (2008-2009). Nineteen patients who had venous thromboembolic manifestations were subjected to inferior vena cava filter insertion. The main reasons for inferior vena cava filter insertion were the occurrence of venous thromboembolism on top of anticoagulants, and bleeding resulted from heparin induced thrombocytopenia. All of the patients were presented with one or more risk factors and co-morbidities among malignancies were the most common (52.6%). Insertion was successful for all cases, except one patient who had pre-existing massive inferior vena cava thrombosis. No complications wer...
The late outcomes of vena cava filters in the prevention of pulmonary embolism
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2003
Pulmonary embolism (PE) is the most serious complication of deep venous thrombosis (DVT) resulting in high morbidity and mortality rate. The purpose of this study is to evaluate the long-term results of vena cava filters (VCFs) placement for prevention of PE in high- risk patients. Between June 1999 and March 2002, at the Trauma and Surgical Emergency Service of Istanbul Medical Faculty, 15 high-risk patients who underwent placement of filters were evaluated. There were eleven males (73%) and four females (27%) with mean age of 50 years (range 14 to 76). Eleven of VCFs were placed for prophylactic and four for therapeutic purposes. The indications of VCFs placement are as follows: Spinal cord injury with life-long paraplegia in eight and quadriplegia in two patients, venous thromboembolism while on anticoagulation in two patients, contraindications to anticoagulation in three patients. The mean duration of follow-up was 17 months (range 3-32 months). No patients developed DVT and re...
MAEDICA – a Journal of Clinical Medicine, 2013
Cases of pulmonary embolism (PE) with contraindication of anticoagulation have low incidence. Under these circumstances the placement of an inferior vena cava (IVC) filter may be life-saving. Paradoxically, the presence of the filter imposes anticoagulation itself, due to the risk of filter thrombosis, promoting stasis and increasing the risk of filter related deep venous thrombosis (DVT) and PE recurrence by means of a substantial collateral venous return that bypasses the IVC filter (1,2). We present the case of a woman with DVT, complicated with high risk PE. After thrombolysis with alteplase the patient develops retroperitoneal hematoma originating from undiagnosed renal angiomyolipoma. Therefore long term anticoagulation is considered contraindicated and an IVC filter is installed. Shortly after hospital release the patient presents occlusion of the IVC filter with DVT recurrence. The initiation of low molecular weight heparin and afterwards of acenocumarol has a favorable outc...
Pulmonary Circulation
Twenty percent of patients with Cancer Associated Thrombosis receive an inferior vena cava filter annually. Insertion is guided by practice guidelines, which do not specify or discuss the use of inferior vena cava filters in malignancy. Adherence to these guidelines is known to be variable. We aimed to see if there was consistent management of venous thromboembolism among Medical Oncologists/Haematologists and Respiratory Physicians, with respect to inferior vena cava filter use in the setting of suspected and confirmed malignancy. Medical Oncologists, Haematologists and Respiratory Physicians were surveyed with four theoretical cases. Case 1 concerns a patient who develops a pulmonary embolism following spinal surgery. Cases 2 and 4 explore the use of inferior vena cava filters in the setting of malignancy. Case 3 covers the role of inferior vena cava filters in recurrent thrombosis despite systemic anticoagulation. There were 56 responses, 32 (57%) Respiratory Physicians and 24 (4...
Inferior vena cava filters in pulmonary embolism: A historic controversy
Archivos de cardiologia de Mexico, 2017
Rationale for non-routine use of inferior venous cava filters (IVCF) in pulmonary embolism (PE) patients. Thrombosis mechanisms involved with IVCF placement and removal, the blood-contacting medical device inducing clotting, and the inorganic polyphosphate in the contact activation pathway were analyzed. In addition, we analyzed clinical evidence from randomized trials, including patients with and without cancer. Furthermore, we estimated the absolute risk reduction (ARR), the relative risk reduction (RRR), and the number needed to treat (NNT) based on the results of each study using a frequency table. Finally, we analyzed the outcome of our PE patients that were submitted to thrombolysis with short and long term follow-up. IVCF induces thrombosis by several mechanisms including placement and removal, rapid protein adsorption, and simultaneous surface-induced activation via the contact activation pathway. Also, inorganic polyphosphate has an important role as a procoagulant, reversi...
World Journal of Cardiovascular Surgery
Inferior vena cava (IVC) filters have since been implanted in the 1970s. The aim of implantation is to prevent the occurrence of fatal pulmonary embolism (PE). However, fatal pulmonary embolisms have been occurring after filter insertion. The mechanism is that either a thrombus or an embolus was already located cranial to the site of deployment of the filter within the inferior vena cava. And so after the filter implantation significant embolism can still occur. We present the case of a 62-year-old woman who had an IVC filter but died two weeks later from pulmonary embolism, through an unusual mechanism. The patient had a fracture of the left tibia, had open reduction and internal fixation developed pulmonary embolism secondary to deep vein thrombosis of the left lower limb. Anticoagulation was started, an IVC filter was inserted and she was discharged home with a therapeutic INR. However, she passed away two weeks later from pulmonary embolism, through the unusual mechanism of thrombus propagation across the IVC filter. The clinical significance of this article is to draw clinicians' attention to the existence of another mechanism of fatal pulmonary embolism after an IVC filter insertion. The thrombus can propagate across the IVC filter leading to fatal pulmonary embolism.
Journal of Vascular Surgery, 1998
Purpose: It has been proposed that inferior vena cava filter placement should be the initial treatment of deep venous thrombosis (DVT) or pulmonary embolus (PE) in patients with coexisting malignant disease. We have chosen instead to selectively place filters only in patients with either a contraindication to anticoagulation therapy or a subsequent complication from anticoagulation therapy. The treatment efficacy and mortality rates in patients with concomitant malignant disease and venous thromboembolism using this approach was determined. Methods: We retrospectively reviewed all patients at our institution with malignant disease in whom venous thromboembolism developed between August 1991 through August 1996 and identified 166 patients with PE (n = 8), DVT (n = 147), and DVT/PE (n = 11). Of these patients, 138 (83.1%) were initially treated with anticoagulation therapy, and 28 (16.9%) had primary filter placement because of contraindications to anticoagulation therapy (10 for intracranial tumors, 11 for recent or upcoming operations, 6 for recent hemorrhage, and 1 for a malignant bloody pericardial effusion). Results: Thirty-two (23%) of the 138 patients who initially underwent anticoagulation therapy subsequently required a filter for the following reasons: bleeding (n = 15, 10.9%); recurrent thromboembolism (n = 6, 4.3%); heparin-induced thrombocytopenia (n = 1, 0.7%); and perceived high risk for bleeding with continued anticoagulation therapy (n = 11, 8%). Both bleeding and recurrent thromboembolism developed in 1 patient. Sixty patients (36%) received filters. No major technical complications occurred from filter placement. Major recurrent thromboembolic complications developed in 10 patients: DVT (n = 6, 10%), PE (n = 2, 3.3%), inferior vena cava thrombosis and phlegmasia cerulea dolens (n = 1, 1.7%), superior vena cava thrombosis (n = 1, 1.7%). Venous gangrene developed in 1 patient with DVT. The 1-year actuarial survival rates for patients treated with filter and anticoagulation therapy were 35% and 38%, respectively (P = NS). Conclusion: In summary, our experience suggests that 64% of patients with malignant disease and venous thromboembolism are effectively treated with anticoagulation alone; 17% require primary filter placement for standard indications, and an additional 19% require subsequent filter placement because of complications (primarily bleeding) or failure of anticoagulation therapy. Although technical complications of filter placement are low, serious life-threatening or limb-threatening thromboembolic complications developed in 17% of patients. Survival was poor in all patients, regardless of treatment. These data support a conservative approach of routine anticoagulation therapy with selective filter placement. (J Vasc Surg 1998;28:800-7.)
There is an increasing use of inferior vena caval filters (IVCFs) as prophylactic activity in the absence of a deep venous thrombosis (DVT) to prevent pulmonary embolism (PE) in high-risk patients. These devices are effective in preventing PE in the presence of lower extremity DVT, when anticoagulation is contraindicated or has failed. An electronic databases search of MEDLINE, PubMed, The Cochrane Library, and Google Scholar for relevant articles listed between January 2000 and December 2014 was performed. The review was confined to patients without a history of previous venous thromboembolism and no evidence of changes on venous duplex imaging suggestive of previous DVT. At present, the use of prophylactic IVCF is predominantly in the trauma, orthopedic, and bariatric surgical populations. Currently, no class I studies exist to support insertion of an IVCF in a patient without an established DVT or PE. However, there is a body of class II and class III evidence that would support the use of IVCFs in certain "high-risk" patients who do not have a documented DVT or the occurrence of a PE. Widespread use of prophylactic IVCFs is not supported by evidence and should be discouraged.
Respiratory Medicine, 2002
The use of inferior vena cava (IVC) filter for massive pulmonary emboli (PE) with cardiopulmonary instability has not been clinically studied. We present a case series of six such patients who received an IVC filter with anticoagulation rather than thrombolysis because of high risk of bleeding. Acute pulmonary embolectomy was considered, but was not possible for a variety of individual clinical situations. These six hospitalized patients prospectively followed during their admission. They were triaged to three medical intensive care units (ICUs) and one surgical ICU in three university teaching hospitals. One patient was transferred from another institution. All six patients had severe hypoxia and tenuous cardiopulmonary status. All required high inspiratory oxygen and hemodynamic support; two required mechanical ventilation and vasopressors. An IVC filter was placed emergently and anticoagulation was started immediately. All six patients had resolution of pulmonary thromboemboli (PTE) on anticoagulation while the IVC filter prevented further PE. All six patients were discharged home in their pre-critical illness state. None of the patients suffered complications from this therapy and had excellent resolution of cardiopulmonary collapse. The IVC filter placement prevented further major embolic events while the PTE resolved with anticoagulation. An IVC filter should be considered as an adjunct to anticoagulation therapy for those patients with massive PE and cardiopulmonary instability who are not candidates for thrombolysis, and acute pulmonary embolectomy is not readily available or is of very high risk.