Recent Experience with Inferior Vena Cava Filters

Abstract

Inferior vena cava filter (IVCF) is intended to prevent pulmonary artery thromboembolism (PTE). Early retrieval of IVCF has been recommended because of complications associated with long-term implantation, but retrieval of IVCF with a large, trapped thrombus may cause PTE. From April 2017 to December 2021, we had 308 cases of venous thromboembolism (VTE). There were 271 cases of deep vein thrombosis (DVT) of the lower extremities (of these, 148 cases were proximal DVT). We examined twelve patients with IVCFs implantation (3.9% of all VTE and 8.1% of proximal DVT). Inserted IVCFs were 1 NEUHAUS PROTECT SE, 2 OptEase and 9 ALN. Three filters were not retrieved, four filters were retrieved without filter thrombus on imaging, three filters were retrieved with filter thrombi smaller than 2 cm, and two filters were retrieved with thrombi larger than 4 cm after intensive therapy of direct oral anticoagulants (DOAC). All patients had not symptomatic PTE. All patients on intensive therapy of DOAC had no bleeding complications. In case that thrombolysis has bleeding risks, it is suggested that IVCF retrieval is possible without symptomatic PTE by reducing the size of filter thrombus with intensive therapy of DOAC. While the frequency of IVCF use has decreased after the guideline revision, we also considered the appropriate use of IVCF.