Clinical Experience of Vena Cava Filter for Deep Vein Thrombosis

Abstract

As of June 2000, forty-eight patients underwent insertion of vena cava filter for deep vein thrombosis. Filter placement was indicated because of wide spreaded deep vein thrombosis (DVT), acute pulmonary embolism (PE), and recurrent PE despite adequate anticoagulation. After insertion of a permanent filter, anticoagulation therapy was completed to control the underlying thrombotic process unless there was a contraindication. During placement of a temporary filter, anticoagulation therapy and/ or thrombolysis was instituted as soon as possible. In cases of pulmonary embolectomy, filters were inserted after hemodynamics became stable with embolectomy. In cases of deep vein thrombectomy and urological or gynecological operations, filters were inserted before these operations for fear of thrombus migration during these procedures. There were no complications regarding filter insertion such as hematomas, wound infections, or perioperative PE. Temporary filters were removed after the purpose was accomplished without any complications within 5 to 9 days after filter insertion. A long term follow-up study for all patients with a mean follow-up period of 26±22 months (range, 1 to 121 months) was carried out. Four patients (8.3%) had recurrent nonfetal PE after insertion of permanent filters because of insufficient anticoagulation therapy. The operative mortality rate was 8.3% (44/48), although none of the four deaths were related to filter insertion or recurrent PE. Four patients died of sepsis, lung cancer, uterus cancer, and dilated cardiomyopathy. Vena cava filter insertion is safe, and effective for prevention against fatal pulmonary thromboembolism. Temporary filter insertion would become popular in the near future.