Inferior vena cava filter

An inferior vena cava filter (IVC filter) is a type of vascular filter, a medical device that is implanted by interventional radiologists or vascular surgeons into the inferior vena cava to presumably prevent life-threatening pulmonary emboli (PEs). Their effectiveness and safety profile is not well established, and in general, they are only recommended in some high-risk scenarios. They are not intended to be a replacement for medical (drug-based) management of venous thromboembolism (VTE). However, in cases where patients are at high risk of developing a clinically significant PE and cannot be sufficiently anticoagulated, placement of an IVC filter may be recommended.

To date, there has been only one randomized controlled trial completed on IVC filters. This study found that IVC filters reduced the incidence of PE but increased the incidence of deep vein thrombosis (DVT). All patients were on anticoagulation drugs during the study. Results from the PREPIC study and other studies which have shown many long-term complications of IVC filters led to the introduction of retrievable IVC filters. The first retrievable IVC filters were approved by FDA in 2003 and 2004.

In 2012, the American College of Chest Physicians recommended IVC filters for those with contraindications to anticoagulation who either have acute PE or acute proximal (above the knee) deep vein thrombosis (DVT).

While the ability to retrieve a filter does exist for many models, it cannot be guaranteed that all cases of filter placement will allow for, or be indicated for retrieval. Thus, the requirements and indications for permanent placement of filters is used to decide on when to use both permanent and temporary IVC filters.

Long-term risk factors must be considered as well, to include life expectancy of more than six months following insertion, and the ability of the patient to comply with anticoagulation therapy. The decision to use a filter that is temporary vs permanent basically is tied to the expected duration of time that protection is needed to prevent pulmonary emboli from passing to the heart and lungs. One such guideline is outlined below:

While many studies have been done on the efficacy of Vena Cava filters, there still have not been any major studies done on the actual placement and removal of the filters regarding standard guidelines. Which is why the Society of Interventional Radiology created a multidisciplinary panel that developed the following guidelines to see if someone qualifies for implantation:

...
Wikipedia