Inferior Vena Cava Filters: Retrospective Review of a Single Center Experience

Background: Venous thromboembolism is a preventable culprit of Pulmonary Embolism. PE remains a source of significant mortality and morbidity in Saudi Arabia, its exact incidence remains unknown, however, deaths due to VTE and PE range from 10-12% in inpatients. While most patients are managed by oral anticoagulants; many risk factors preclude their use and recurrent PE remains a major risk. IVC filters has been introduced since 1969, many filter types were developed since then which had better outcomes and less complications. In this review, we explored the indications, success and complications rate of IVC insertion in a large tertiary hospital in Saudi Arabia to compare it to the trends reported in the latest edition of Guidelines in the United States and Europe (CIRSE). Method(s): The medical charts of patients who had IVC insertion from 2011-2016 years were reviewed. Indications of insertion, outcomes, complications of IVC were collected. Categorial variables were summarized as proportion and percent. Continuous variables were summarized as mean and standard deviation. Data was analyzed using SAS. Result(s): Total of 411 patients were eligible based on the inclusion criteria. 61.07% males, 38.93% females. The main referring departments were Internal Medicine, Orthopedics, and Emergency Room 15.54% (n= 55), 13.84% (n= 49), 12.99% (n=13.84), respectively. Main indication for filter insertion in our sample was calculated based on the latest SIR guidelines. the most common indication of insertions was Absolute or relative contraindication to Oral anti coagulants 131 (37.86%) followed by PE or DVT and transient inability to anticoagulate in 65 (18.79%). 2.94% had history of thrombophilia and one patient (0.24) pregnant at the time of insertion and had thrombosis as a late complication. While 18.79% (n=65) of our patients did not have a clear indication documented to insert IVC filters. Thrombotic events were calculated in our sample and 52.94% (n=216) had only one thrombotic event. An increase of filters insertion was noted from 2011 (n=57) to 2016 (n=89). The institution has all filter types available most of the time, yet, Optease filters were inserted mostly (75.31%) followed by Denali (15.65%). 97.32% (n= 399) of filters were inserted infrarenally, while 2.20% were inserted suprarenally (n=9). In 0.49% (n=2) of our patients, IVC filter was inserted in the common iliac vein. We have lost long follow up due to different reasons in 55.42% (n=225) of our patients which is significant despite the follow up measures taken in our institution. Immediate complications did not occur in 83.90% (n=344). Most common immediate complication was tilting 13.66% (n=56). Mean duration of filter in situ was 91.91 days. No late complications occurred in 40.25% (n=163). Loss of follow up due to death and other causes occurred in 27.90% (n=113) and 21.48% (n=87), respectively. Most common late complication was Thrombosis 9.38% (n=38). Successful retrieval rates varied between years. IVC thrombus complicated retrieval in 1.97% of patients (n=8) and failure to retrieve due to other comorbidities and implications occurred in 1.48% (n=6). Conclusion(s): We have observed IVC Insertion problems similar to international reported figures. The rate of Insertion problems was 5-23% in the US, while it was 16.1% (n=66) in our sample. Filter movement was reported in 0-18% in the US, whereas it was 0.49% in ours (n=2). Retrieval was successful in 84.97% (n=153) of patients who followed up, 50.62%, compared to 34% in the US. IVC filter penetration occurred in 0.49% (n=2) of our patients which significantly lower than the range reported in US (0-41%) which could be due to loss of follow up in our sample. Compared to the International standard considered by our institution, our sample had similar thresholds. In summary, IVC filter placement in our institution had minimal complications and is similar. The rate of mortality was 0.24%.

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Artikel online veröffentlicht:
11. Mai 2021