When do you use IVC
filters?
Jeffrey Wang MD
Horizon Vascular Specialists
Director of Vascular Research
Shady Grove Adventist Hospital
DVT and PE
DVT in the U.S.: • Symptomatic PE is the most important acute
complication of DVT
– 600,000 new DVT cases a year
– Responsible for 200,000 deaths (more than combined deaths from AIDS and breast cancer)
– Leading cause of preventable in-hospital mortality
• Diagnosis is confirmed in only 20-30% of ER patients with clinically suspected DVT
Sources:
• Society of Vascular Surgeons website, www.vascularweb.org, 1-6-06
• Schreiber, D. Deep venous thrombosis and thrombophlebitis.
www.emedicine.com/emerg/topic122.htm, last updated October 2005.
2414-001 9/11 Slide #
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Symptoms
• Dyspnea 78%
• Pleuritic chest pain 59%
• Cough 43%
• Leg pain 27%
• Hemoptysis 16%
• Palpitations 13%
• Wheezing 14%
• Angina like pain 6%
Signs
Tachypnea (20/min) 73%
Crackles 55%
Tachycardia (>100/min) 30%
Leg swelling 31%
Loud P2 23%
DVT 15%
Wheezes 11%
Diaphoresis 10%
Temperature (≥38.5°) 7%
Pleural rub 4%
Fourth heart sound 24%
Third heart sound 5%
Cyanosis 3%
Homans' sign 3%
Anticogaulation
• First line treatment of DVT and PE is
antigoagulation
• IVC interruption is an option if
anticoagulation is not possible
History
• 1893 Bottini-Ligates IVC
• 1959 Moretz- External clip of IVC
• 1973 Greenfield 1st IVC filter
Vena Cava Filter Indications
• Deep Venous Thrombosis and or
Pulmonary embolism
• Significant risk for falling
• Pt not able to tolerate anticoagulation
• Pt unable to tolerate additional PE
• New DVT or PE while on therapeutic
anticoagulation
Clinical Scenarios
• 84 yo female s/p right hip pining 1 wk
ago presents with right poplitial DVT
• 65 yo male with bilateral PE in ICU on
ventilator on pressors. O2 Sat 85%
• 68 yo female with GI Bleed and Left
Femoral DVT
• 72 yo male with atrial fibrillation on
therapeutic anticoagulation. Develops
a new right popliteal DVT. INR is 2.5
Some Other Controversial Indications
• BMI > 55 undergoing gastric bypass – There is data to suggest that prophylactic
filters reduce the amount of PEs
• Prior history of PE undergoing major orthopedic surgery – No evidence that once anticoagulation
treatment has been completed that there is additional benefit
• Oncologic Disorder with thromboembolic event – Effective in preventing PE but doesn’t seem
to convey a survival benefit
Some Other Controversial Indications
• Trauma and paraplegia or
quadriplegia
– There is a reduction in fatal PE, but higher
rate of recurrent DVT
– EAST recommends prophylactic filter in
high risk trauma patients
– ACCP does not recommend prophylactic
filters in the same group
• Hypercoagulable state
– Not appropriate for prophylaxisis
List of available IVC filters
Retrievable
• Celect (Cook)
• Gunther Tulip (Cook)
• Denali(Bard)
• Optease(Cordis)
• ALN (ALN)
• SafeFlo (Rafael)
• Option (Rex)
• Crux (Crux)
Permanent
• Simon Nitinol (Bard)
• Vena Tech (Braun)
• Vena Tech LP (Braun)
• Greenfield (BSCI)
• Trapease (Cordis)
• Bird’s Nest (Cook)