Inferior Vena Cava Filters

Prepared by Michael Ricci, MD

Corresponding chapter in Handbook of Venous Disorders: Chapters 20, 22 and 25

• Greenfield LJ, Michna BA. Twelve-year clinical experience with the Greenfield vena caval filter. Surgery 1988;104:706-12.

PMID: 3175867

Comment: Long term follow up of the original Greenfield IVC filter published in 1988 still represent outcomes to be emulated.

• Rogers FB, Shackford SR, Wilson J, Ricci MA, Morris CS. Prophylactic vena cava filter insertion in severely injured trauma patients: Indications and preliminary results. J Trauma 1993;  35:637-42.

PMID: 8411290

Comment: This preliminary report initiated multiple studies and persistent controversy regarding the prophylactic use of IVC
filters for severely injured trauma patients. The percutaneous Greenfield IVC filter performed well in a high risk group of patients.

• Corriere MA, Suave KJ, Ayerdi J, Craven BL, Stafford JM, Geary RL, Edwards MS. Vena cava filters and inferior vena cava thrombosis. J Vasc Surg 2007;45:789-94.

PMID: 17398389

Comment: Though this is a retrospective analysis of retrievable and permanent vena caval filters, it provides a perspective of the two different techniques. Device selection, limitations, and complications of both devices are highlighted.

• Participants in the Vena Caval Filter Consensus Conference. Recommended reporting standards for vena caval filter placement and patient follow-up.  J Vasc Surg 1999; 30:573-9.

The use of vena caval filters has increased significantly since the introduction of percutaneous placement techniques and the development of reduced profile devices. The literature contains hundreds of reports of immediate and long-term outcomes for patients in whom these devices have been placed, but the reports do not use consistent standards, definitions, or techniques, making it difficult to compare outcomes and determine the relative efficacy and safety of the available devices. Successful deployment of a vena caval filter fundamentally requires a patent filter, properly positioned within the vena cava in a manner that protects against pulmonary embolism. With this premise, reporting standards have been developed to assess caval filter placement, function, and other outcome parameters. They are applicable to all vena caval filters, regardless of other reportable aspects: basic design, manufacturer, the specialty of the clinician placing the device, the indications for which it was placed, and whether it was intended for permanent or temporary use. These data should be evaluated with rigorous statistical methods to allow unbiased comparisons that should lead to improved outcomes forpatients. Extensive literature citations have been included, either to highlight the significance of each standard or to provide examples of typical reports.

PMID: 10477662

Comment: This is a critical paper for anyone interested in vena cava filters. Knowledge of reporting standards summarized in this article is not only for the clinical investigator but also for the knowledgeable reader who must interpret published articles and apply their findings to daily clinical practice.

• Passman MA, Dattilo JB, Guzman RJ, Naslund TC. Bedside placement of inferior vena cava filters by using transabdominal duplex ultrasonography and intravascular ultrasound imaging.  J Vasc Surg 2005;42:1027-32.

PMID: 16275468

Comment: These authors challenge the traditional fluoroscopic method of IVC filter placement, describing techniques for bedside placement with transabdominal and/or intravascular ultrasound. This augments the capabilities of the vascular specialist.