[Current indications for inferior vena cava interruption].
Clinical indications of vena cava interruption are reviewed. During the last few years pulmonary embolism frequency remained high and many new percutaneous vena caval filters became available. These facts probably explain the increasing use of these filters reaching about 10,000 filters each year in France. Existing data show that: embolic risk with antithrombotic agents is less than 5%, probably not far greater than embolic risk with cava filters (about 2%); complications encountered with the filters are caval thrombosis in 8%, and more or less than 4% other major complications; there is no controlled study comparing antithrombotic treatment associated with caval filters to antithrombotic treatment alone; there is no controlled study comparing new cava filters among them or to the Greenfield filter; economical implications of caval filters are mostly unknown. The only admitted indications of vena cava interruption, in case of proximal venous thrombosis, are contraindications to anticoagulation. In other situations no data allow to recommend a cava filter; indication will be discussed on a case by case basis. Prospective controlled studies are greatly encouraged.
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Service d'urgences et réanimation médicales, hôpital Bellevue, Saint-Etienne.
Decousus
H
H
Comtet
C
C
Mismetti
P
P
Tardy
B
B
Bertrand
J C
JC
D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008026:Ligation; D011655:Pulmonary Embolism / Q000517:prevention & control*; D012008:Recurrence; D013927:Thrombosis / Q000517:prevention & control / Q000628:therapy*; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior / Q000601:surgery*; D014812:Vitamin K / Q000037:antagonists & inhibitors
D014812:Vitamin K; D006493:Heparin
Indications actuelles des interruptions de la veine cave inférieure.