Pulmonary embolism (PE) most often occurs in the setting of lower extremity deep venous thrombosis (DVT) and is a major contributor to morbidity and mortality worldwide. First-line therapy is systemic anticoagulation (AC), but some patients have contraindications. Additionally, treatment may be ineffective at PE prevention or result in undesirable side effects such as spontaneous bleeding. In these patients, inferior vena cava (IVC) filters can be placed to provide mechanical clot filtration to prevent PE in the setting of DVT. First introduced in the 1960s, IVC filters have evolved into low-profile devices, which can be deployed percutaneously. A variety of models are available on the market today, including permanent and optional (retrievable) devices, the latter allowing for retrieval once the period of venothromboembolism (VTE) risk has elapsed. Standard technique for IVC filter retrieval includes the use of endovascular snares; however alternative methods such as endobronchial forceps or laser sheath ablation may be needed in complicated cases. Studies have shown the efficacy of IVC filters for reducing the risk of recurrent symptomatic PE but have also revealed an increased risk for DVT. There has also been increasing recognition of device-related complications, including filter migration, fracture, and penetration through the IVC wall, which can lead to significant clinical sequelae. Consequently, it is essential to place IVC filters in appropriately selected patients and provide vigilant follow-up to remove the filters as soon as clinically indicated.
KeywordsInferior vena cava filter Venothromboembolism Deep venous thrombosis Pulmonary embolism Anticoagulation
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