There is currently very sparse data regarding inferior vena cava filter usage. Whether it is to do with the safety and efficacy of filters, the complication rates for different devices or even clear data on why they are implanted in the first place—these are all areas backed by very little research.
Patients with venous thromboembolic disease are usually treated appropriately with anticoagulation. Many patients who cannot be anticoagulated have been treated with inferior vena cava filters. There has also been an increase in the number of prophylactically (this is also considered off-label use as the patients do not have venous thromboembolism) placed filters, for instance before spinal surgery or for patients who have suffered trauma and were thus considered to be at risk for venous thromboembolic disease. Recently, there has also been an increase in the number of recognised filter–related complications, such as migration, perforation, fracture, or caval thrombosis.
Matthew S Johnson, professor of Radiology and Surgery, Indiana University School of Medicine, and director of Interventional Oncology, Indiana University Health, USA, recommends that physicians who implant filters, must, in the absence of evidence, consider the following checklist.
- Be aware of the SIR guidelines for filter use and stick to them.
- Ensure that the indication for filter placement is appropriate
- Ensure that there is a plan; is future filter retrieval desired?
- Ensure that the most appropriate device available is being used
- Follow your patients!
“It is important that physicians implanting inferior vena cava filters, especially retrievable ones, follow patients in whom those filters are placed. Follow-up brings complications to light and increases the rate of removal when filters are no longer necessary,” Johnson said.