Complications Associated with Long-term Placement of Retrievable Inferior Vena Cava Filters

Abstract

Objective: The reported complications of long-term placement of inferior vena cava filters including filter breakage, strut penetration, thrombotic obstruction, and displacement. This retrospective study investigated the incidences of penetration and breakage for two types of optional filters, the Günther Tulip (GT) and OptEase (OE), which were placed permanently at our hospital. Study patients and methods: The study included 75 patients diagnosed with deep vein thrombosis of the lower limbs who underwent permanent placement of optional filter (GT and OE in 21 and 54 patients, respectively); consecutive computed tomography (CT) scans of the filters were obtained at our hospital between 2003 and December 2014. CT scan data were reconstructed to generate 3D images using multiplanar reconstruction and volume rendering, and visually examined for potential strut penetration into other organs and filter damage. Results: Strut penetration was observed in 15 patients with GT placement (71.4%). The sites of penetration included the aorta (3 patients), right common iliac artery (2 patients), duodenum (3 patients), major psoas muscle (1 patient), intervertebral disc (1 patient), and adipose tissue (5 patients). Meanwhile, filter breakage was identified in 8 patients with OE placement (14.8%). These breakages occurred in the vertical framework on the aortic side (3 cases) and vertebral side (5 cases). The rate of breakage increased over time. Strut penetration was not observed with OE placement, and breakage was not observed with GT placement. None of the patients with penetration or breakage experienced adverse events. Conclusion: The frequency of confirmed complications with optional filters in the present study was very high. Therefore, unnecessary permanent filter placement should be avoided whenever possible. The decision for permanent filter placement should be made after thorough assessment of the risks and benefits while considering the potential for complications. In addition, development of a safer filter for permanent placement is desirable for patients at increased risk of recurrence of serious venous thromboembolism who require permanent inferior vena cava filter placement.