Tina R. Desai, Omar C. Morcos, Benjamin B. Lind, Nancy Schindler, Joseph A. Caprini, David Hahn, David Warner, NavYash Gupta
NorthShore University HealthSystem, Skokie, IL.
OBJECTIVES: Retrievable IVC filters are appealing because they are designed for either retrieval or long-term use. However, their long-term safety compared to permanent filters is largely unknown. This study was undertaken to compare complication rates and types associated with retrievable and permanent filters.
METHODS: A retrospective review identified 1231 IVC filters (447 retrievable, 784 permanent) placed in 1,227 patients from 2005-2010. Patients with retrievable filters removed electively were excluded, yielding 382 patients (Group A) in whom retrievable filters were left in place. These patients were compared to those with permanent filters (Group B) with respect to demographics, comorbidities, survival, and complication rate and type. Differences in patient characteristics were tested with Chi square, Fisher exact and Wilcox rank-sum tests. Logistic regression was used to identify predictors of complications.
RESULTS: Group A patients were younger than those in Group B (mean age 64 vs. 75, p<0.0001). Group A had significantly more complications than group B (9.7% vs. 1.9%, p<0.0001) after mean follow up of 20 months (range 0-86 months). Furthermore, retrievable filter type was a significant predictor of complications in a multivariate model (odds ratio 5.4, p<0.0001). Filter complications were categorized as thrombotic, device related, or systemic. While the most common complication type with retrievable filters was device related (52%) and with permanent filters was thrombotic (63%), both thrombotic and device related complications occurred more frequently in group A than Group B (thrombotic 3.6% vs. 1.5%, p=0.02; device related 5% vs. 0.5%, p<0.0001).
CONCLUSIONS: Indwelling retrievable IVC filters were associated with significantly higher complication rates than permanent filters. Both thrombotic and device related complications were more common with retrievable filters. Long-term use of retrievable filters should be avoided, especially considering the younger population in whom they are placed.
AUTHOR DISCLOSURES: J. A. Caprini: Nothing to disclose; T. R. Desai: Nothing to disclose; N. Gupta: Nothing to disclose; D. Hahn: Nothing to disclose; B. B. Lind: Nothing to disclose; O. C. Morcos: Nothing to disclose; N. Schindler: Nothing to disclose; D. Warner: Nothing to disclose.
Posted April 2013