Vena Cava Filter Deployment Prior to Percutaneous Endovenous Therapy for Proximal Lower Limb Deep Venous Thrombosis: Should we Routinely Practice?

Background: Anticoagulant therapy remains the prevalent treatment for venous thromboembolism (VTE). In the new era of percutaneous endovenous intervention, there is a progressive raise in the use of percutaneous endoluminal clot dissolution techniques as catheter directed thrombolysis (CDT) and mechanical aspiration thrombectomy (MAT) devices due to its established shortterm benefits. Prophylactic Deployment of inferior vena cava (IVC) filter during percutaneous endovenous therapy for lower extremities deep venous thrombosis (DVT) is still debatable issue. Method(s): Percutaneous endoluminal clot dissolution using either CDT or MAT for proximal lower extremity DVT was performed on 64 limbs in 58 patients of 148 patients diagnosed with proximal acute / subacute DVT in vascular surgery department of study hospitals. IVC filter was deployed in 31 patients prior or during the procedure. Result(s): From 58 patients were treated for proximal DVT with clot debulking procedures, IVC filter was prophylactically deployed in 30 patients (51.7%). Trapped thrombus in the deployed filters as revealed on venocavography was observed in 8/30 (26.7%) filters deployed prophylactically with overall rate of thrombus embolization during percutaneous endovenous thrombus dissolution techniques was 11/58 patients (18.9%). Conclusion(s): Catheter directed thrombolysis could be done safely and effectively without routine prophylactic IVC filter placement in treating acute DVT. Selective filter placement may be considered in patients undergoing mechanical thrombectomy or patients with more proximal thrombus pattern with multiple risk factors.

 

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Publication History

Article published online:
11 May 2021