Is the increasing use of prophylactic percutaneous IVC filters justified?
To determine whether the ease of percutaneous inferior vena cava (IVC) filter placement has led to an alteration of procedural indications, we reviewed the medical records of 150 patients who underwent 156 filter insertions from January 1986 through June 1993. Thirty-nine Greenfield filters were surgically inserted, while 117 percutaneous devices were placed in 111 patients. A comparison of these two groups showed that they had similar thromboembolic risks. Indications for surgical filter placement included pulmonary embolism (PE) prophylaxis (23%), PE with a contraindication to anticoagulation therapy (28%), and complication (26%) or failure (20%) of anticoagulation therapy. Indications for initial percutaneous placement included PE prophylaxis (56%), PE with a contraindication to anticoagulation therapy (27%), and complication (7%) or failure (9%) of anticoagulation therapy. Early mortality in the surgical and percutaneous groups was 26% and 27%, respectively. Ten percent of early deaths in the surgical group and 50% in the percutaneous group were associated with prophylactic insertions (P = 0.032). Associated morbidity was 8% in the surgical versus 24% in the percutaneous group (P = 0.036). The unrestricted use of prophylactic percutaneous IVC filters appears to have resulted in an increased procedure-related morbidity with no clear benefit in early patient survival. These findings suggest a need for improved patient selection.
Alexander
J J
JJ
Department of Surgery, Case Western Reserve University, Cleveland Metropolitan General Hospital, Ohio 44109.
Yuhas
J P
JP
Piotrowski
J J
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000075202:Contraindications; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin; D013924:Thrombophlebitis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D016896:Treatment Outcome; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior
D000925:Anticoagulants