Anne Roberts, UCSD Thornton Hospital, La Jolla, San Diego, USA, spoke to delegates at the International Symposium on Endovascular Therapy (ISET), 18–23 January 2013, Miami, Florida, USA, on the topic of indications for retrieval inferior vena cava filters, retrievable rates and contemporary issues which accompany filter implementation.
Roberts said that the expanded indications for filters included: free-floating thrombus, severe trauma, deep vein thrombosis, pulmonary embolism, venous thrombolysis and deep vein thrombosis with existing severe cardiac or pulmonary disease. She added that retrievable filters have potential uses for hip, knee and bariatric operations, and neurosurgical procedures.
In the presentation, the speaker discussed the use of permanent filters instead of retrievable and said: “For many patients it may be appropriate”. However, she added that when implementing a permanent filter that late development of deep vein thrombosis (20% with permanent filter vs. 11.6% with no filter), inferior vena cava thrombosis, filter fracture, migration, perforation and guidewire entrapment are concerns.
Roberts said, in the case of retrievable filters, “It is clearly possible to improve our rate of retrieval.” She recommended using retrievable filters when necessary and but remaining aware of the broadening indications, to follow-up patients, to remove the filter sooner rather than later (but in the case of late removal to do so under general anaesthesia), to administer anticoagulants, and possibly to stent through the filter if it cannot be removed.
The speaker listed different types of inferior vena cava filters which where approved by the FDA:
- ALN Filter—ALN Implants Chirurgicaux
- SafeFlo Filter—Rafael Medical Technologies
- Crux Filter—Volcano Corporation
She also listed filters that have not yet received FDA approval:
- Denali Filter—Bard Peripheral Vascular
- VenaTech Convertible Filter—B Braun
- Veniti Filter—Veniti Endovenous Therapies
- Sentry Bio-convertible Filter—Novate Medical
Roberts, in her conclusion, told delegates about a prospective multicentre study of the Denali Retrievable Inferior Vena Cava Filter which is currently recruiting. The study has a primary outcome measure at six months of technical and clinical success of placement of the filter and subsequent retrieval. The Denali study has a planned enrolment of 200 patients with follow-up at 12, 18 and 24 months.