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The Use of Retrievable Inferior Vena Cava Filters in Severely Injured Trauma Patients: An Analysis with Improved Long-Term Follow-up

Owen N. Johnson, III, David L. Gillespie, Gilbert Aidinian, Paul W. White, Eric Adams, Mitchell Cox, Charles J. Fox.
Walter Reed Army Medical Center, Washington, D.C.

OBJECTIVES: Existing data supporting the retrievability of prophylactic inferior vena cava filters (IVCF) in civilian trauma patients suffer from poor follow-up in this transient population. We hypothesized we could better characterize IVCF use with more complete follow-up in the US military population.

METHODS: This is a retrospective review of prospectively collected data on US soldiers injured in Iraq or Afghanistan (as part of the Global War on Terror) from July 2003 to June 2007. All IVCF evaluations and management were performed by the vascular surgery service.

RESULTS: Seventy-two retrievable IVCF (R-IVCFs) were placed during the study period. Intact follow-up was obtained out to 180 days in 85%. There were 57 patients in which no retrieval attempt was made: 45 of the 72 (63%) were left in place for ongoing indications, one patient died of unrelated causes, and 11 were lost to follow-up during the possible retrieval period. Thirteen were successfully removed in 15 attempts, yielding an overall retrieval rate of 18%. Among these, median dwell time was 47 days [range 10-94]. Of the study group, mean injury severity score (ISS) was 36.3±10.4 and median age was 26 years [range 20-50]. Indications were prophylactic in 24 and therapeutic in 48; median time between injury and IVCF insertion was 8 days [range 1-173]. Both retrieval failures were due to incorporation into the caval wall (at 90 and 156 days). With mean long-term follow-up of 28 (±12) months, there have been no insertion site deep vein thromboses, breakthrough pulmonary embolisms (PE), symptomatic caval occlusions, filter penetrations or caval stenoses. No patients have had PE after IVCF removal.

CONCLUSIONS: This study presents the most complete long-term follow-up of R-IVCFs in trauma patients to date. We found that while R-IVCFs were used safely and effectively in combat casualties with high ISS, few were actually removed. The 18% overall retrieval rate was lower than expected based on existing civilian data, most commonly because R-IVCFs were left in permanently in this severely injured group. Maximum dwell times allowing safe retrieval, and late complication rates of R-IVCFs left in permanently, remain undetermined.

AUTHOR DISCLOSURES: O.N. Johnson, None; D.L. Gillespie, None; G. Aidinian, None; P.W. White, None; E. Adams, None; M. Cox, None; C.J. Fox, None.