Practice patterns and outcomes of retrievable vena cava filters in trauma patients: An AAST multicenter study

Riyad Karmy-Jones, Gregory J. Jurkovich, George C. Velmahos, Thomas Burdick, Konstantinos Spaniolas, Samuel R. Todd, Michael McNally, Robert C. Jacoby, Daniel Link, Randy J. Janczyk, Felicia A. Ivascu, Michael McCann, Farouck Obeid, William S. Hoff, Nathaniel McQuay, Brandon H. Tieu, Martin A. Schreiber, Ram Nirula, Karen Brasel, Julie A. DunnDebbie Gambrell, Roger Huckfeldt, Jayna Harper, Kathryn B. Schaffer, Gail T. Tominaga, Fausto Y. Vinces, David Sperling, David Hoyt, Raul Coimbra, Mathew R. Rosengart, Raquel Forsythe, Clay Cothren, Ernest E. Moore, Elliott R. Haut, Awori J. Hayanga, Linda Hird, Christopher White, Jodi Grossman, Kimberly Nagy, West Livaudais, Rhonda Wood, Imme Zengerink, John B. Kortbeek

Research output: Contribution to journalArticle

195 Scopus citations

Abstract

BACKGROUND: The purpose of this study is to describe practice patterns and outcomes of posttraumatic retrievable inferior vena caval filters (R-IVCF). METHODS: A retrospective review of R-IVCFs placed during 2004 at 21 participating centers with follow up to July 1, 2005 was performed. Primary outcomes included major complications (migration, pulmonary embolism [PE], and symptomatic caval occlusion) and reasons for failure to retrieve. RESULTS: Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% for prophylactic indications and 79% were placed by interventional radiology. Excluding 33 deaths, 152 were Gunter-Tulip (G-T), 224 Recovery (R), and 37 Optease (Opt). Placement occurred 6 ± 8 days after admission and retrieval at 50 ± 61 days. Follow up after discharge (5.7 ± 4.3 months) was reported in 51%. Only 22% of R-IVCFs were retrieved. Of 115 patients in whom retrieval was attempted, retrieval failed as a result of technical issues in 15 patients (10% of G-T, 14% of R, 27% of Opt) and because of significant residual thrombus within the filter in 10 patients (6% of G-T, 4% of R, 46% Opt). The primary reason R-IVCFs were not removed was because of loss to follow up (31%), which was sixfold higher (6% to 44%, p = 0.001) when the service placing the R-IVCF was not directly responsible for follow up. Complications did not correlate with mechanism, injury severity, service placing the R-IVCF, trauma volume, use of anticoagulation, age, or sex. Three cases of migration were recorded (all among R, 1.3%), two breakthrough PE (G-T 0.6% and R 0.4%) and six symptomatic caval occlusions (G-T 0, R 1%, Opt 11%) (p < 0.05 Opt versus both G-T and R). CONCLUSION: Most R-IVCFs are not retrieved. The service placing the R-IVCF should be responsible for follow up. The Optease was associated with the greatest incidence of residual thrombus and symptomatic caval occlusion. The practice patterns of R-IVCF placement and retrieval should be re-examined.

Original languageEnglish (US)
Pages (from-to)17-24
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume62
Issue number1
DOIs
StatePublished - Jan 2007

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Karmy-Jones, R., Jurkovich, G. J., Velmahos, G. C., Burdick, T., Spaniolas, K., Todd, S. R., McNally, M., Jacoby, R. C., Link, D., Janczyk, R. J., Ivascu, F. A., McCann, M., Obeid, F., Hoff, W. S., McQuay, N., Tieu, B. H., Schreiber, M. A., Nirula, R., Brasel, K., ... Kortbeek, J. B. (2007). Practice patterns and outcomes of retrievable vena cava filters in trauma patients: An AAST multicenter study. Journal of Trauma - Injury, Infection and Critical Care, 62(1), 17-24. https://doi.org/10.1097/TA.0b013e31802dd72a