Current controversies in inferior vena cava filter placement: AJR expert panel narrative review

Andrew Kesselman, Thein Hlaing Oo, Matthew Johnson, Michael S. Stecker, John Kaufman, David Trost

Research output: Contribution to journalArticlepeer-review

Abstract

Despite inferior vena cava (IVC) filter practice spanning over 50 years, interventional-ists face many controversies in proper utilization and management. This article reviews recent literature and offers opinions on filter practices. IVC filtration is most likely to benefit patients at high risk of iatrogenic pulmonary embolus during endovenous intervention. Filters should be used selectively in patients with acute trauma or who are undergoing bariatric surgery. Retrieval should be attempted for perforating filter and fractured filter fragments when imaging suggests feasibility and favorable risk-to-benefit ratio. Antibiotic prophylaxis should be considered when removing filters with confirmed gastrointestinal penetration. Anticoagulation solely because of filter presence is not recommended except in patients with active malignancy. Anticoagulation while filters remain in place may decrease long-term filter complications in these patients. Patients with a filter and symptomatic IVC occlusion should be offered filter removal and IVC reconstruction. Physicians implanting filters may maximize retrieval by maintaining physician-patient relationships and scheduling follow-up at time of placement. Annual follow-up allows continued evaluation for removal or replacement as appropriate. Advanced retrieval techniques increase retrieval rates but require caution. Certain cases may require referral to experienced centers with additional retrieval resources. The views expressed should help guide clinical practice, future innovation, and research.

Original languageEnglish (US)
Pages (from-to)563-569
Number of pages7
JournalAmerican Journal of Roentgenology
Volume216
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • Filter retrieval
  • Inferior vena cava filter
  • IVC
  • Venous thromboembolism

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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