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Current Indications For Inferior Vena Cava Filters: Where Do We Draw The Line?

Andre Biuckians, Eric C. Scott, Jessica R Burgess, Jean M. Panneton, George H. Meier, III.
Eastern Virginia Medical School, Norfolk, VA.

OBJECTIVES: The use of inferior vena cava (IVC) filters in patients with deep vein thrombosis (DVT) has dramatically increased over the last twenty years. The indications for IVC filter placement continue to be expanded without new evidence of added benefit. The purpose of this study was to review current indications for IVC filter placement in a large academic vascular surgery practice.

METHODS: A retrospective review of patients who underwent IVC filter placement between June 1, 2004 and June 30, 2006 was performed. Generally accepted indications for IVC filter placement included the diagnosis of proximal DVT or PE in the setting of an absolute contraindication to full anticoagulation. Absolute contraindication to full anticoagulation was defined as active hemorrhage with or without a blood transfusion, concomitant intracranial hemorrhage, thrombocytopenia, or an impending or recent major operation. All other indications were deemed relative.

RESULTS: During this period, 619 patients underwent IVC filter placement and data from 578 (94%) patients were available for review. The mean patient age was 65 years with a median age of 68 years. Thirty-nine patients were < 40 years old (6.7%) and 44% were male. The diagnoses included 398 deep vein thromboses (68.9 %) and 115 pulmonary emboli (19.9 %). Sixty-five patients (11.2 %) carried other diagnoses without a DVT or PE. Overall, 24% of patients had an absolute indication for IVC filter placement. The remaining 72% had relative indications which included relative contraindication to anticoagulation (20.8 %), advanced age (15.4%), DVT/PE with therapeutic INR (9.0 %), history of gastrointestinal bleed (8.1 %), multi-injury trauma (5.2 %), malignancy (5.2 %), perioperative status (5.2%), insufficient anticoagulation (1.7 %), and poor patient reliability(0.5 %). Indications were unknown in 4% of patients. Technical success was 100%. No early complications were reported.

CONCLUSIONS: IVC filter placement is a safe procedure with high technical success. Only a minority of patients received IVC filters for absolute indications. The majority were placed for relative indications with unknown long-term risk. While technically feasible, there is little evidence to support this expansion of relative indications.