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Utility of Retrievable Inferior Vena Cava Filters: A Systematic Literature Review and Analysis of the Reasons for Nonretrieval of Filters with Temporary Indications

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Abstract

Objective

To investigate the use of retrievable inferior vena cava (IVC) filters in the current practice and analyze the causes of filter left in situ despite initial plans for retrieval.

Methods

A systematic search of all English-language studies of retrievable IVC filters was conducted, including clinical trials and observational studies published between January 1984 and March 2016.

Results

A total of 103 studies were identified, including 10 filter models in 20,319 patients. Placement indications were reported for 11,128 (54.8%) patients, including therapeutic (n = 6270; 56.3%) and prophylactic (n = 4858; 43.7%) indications. A total of 13,224 (65.1%) filters were left as permanent devices; 7095 (34.9%) filters were removed. The reasons for filter nonretrieval among the 5308 (40.1%) reported cases were primary permanent indication (21.2%; 1127/5308), death (19.4%; 1031/5308), ongoing pulmonary embolism (PE) protection (19.0%; 1011/5308), failed retrieval (13.7%; 725/5308), loss to follow-up (13.0%; 689/5308), discontinued care (4.4%; 235/5308), physician oversight (4.0%; 213/5308), patient morbidity (2.8%; 149/5308), and patient refusal (2.4%; 128/5308). A total of 7820 patients presented for filter retrieval, and 7095 filters (90.7%) were successfully removed, with a mean indwelling time of 106.6 ± 47.3 days. Breakthrough PE was reported in 2.1% (191/9169) of patients. Filter tilt, recurrent deep vein thrombosis, penetration, IVC thrombosis, migration, and fracture occurred in 7.7% (798/10,348), 7.1% (362/5092), 5.4% (379/7001), 3.9% (345/8788), 1.4% (160/11,679), and 0.5% (50/9509) of patients, respectively.

Conclusions

Approximately two-thirds of retrievable filters were not retrieved even though more than 85% of the filters were initially intended for temporary use. The major reasons for filter left in situ despite initial plans for retrieval were death, need for ongoing PE protection, failed retrieval, loss to follow-up, discontinued care, and physician oversight.

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Funding

Zhongzhi Jia was a research fellow at Mayo Clinic during 2016. He was sponsored by the High-Level Medical Talents Training Project of Changzhou, China (2016CZBJ009).

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Authors and Affiliations

  1. Department of Interventional Radiology, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, 213003, China

    Zhongzhi Jia

  2. Lake Erie College of Osteopathic Medicine, Bradenton, FL, 34211, USA

    Tyler A. Fuller

  3. Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    J. Mark McKinney, Ricardo Paz-Fumagalli, Gregory T. Frey, David M. Sella & Weiping Wang

  4. Department of Radiology, University of Chicago Medical Center, Chicago, IL, 60637, USA

    Thuong Van Ha

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  1. Zhongzhi Jia
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Correspondence to Weiping Wang.

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Jia, Z., Fuller, T.A., McKinney, J.M. et al. Utility of Retrievable Inferior Vena Cava Filters: A Systematic Literature Review and Analysis of the Reasons for Nonretrieval of Filters with Temporary Indications. Cardiovasc Intervent Radiol 41, 675–682 (2018). https://doi.org/10.1007/s00270-018-1880-9

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  • DOI: https://doi.org/10.1007/s00270-018-1880-9

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