Reassessment of vena caval filter use in patients with cancer.
OBJECTIVE
Noting a doubling in mortality soon after placement of filters in the inferior vena cava (IVC) from 1985 (7.8%) to 1992 (15.2%), the authors performed a study to define risk factors associated with death soon after IVC filter placement and to develop revised guidelines for filter placement.


METHODS
During a 4-year period, 141 IVC filters were placed in 137 patients. Patients were divided into two clinical risk groups: those with possible malignancy and those with possible suprainguinal venous thrombus. Survival was monitored for up to 3 weeks after hospital discharge.


RESULTS
Death occurred in 16 (26%) of 61 patients with malignancy (P = .0086, compared with patients without malignancy), seven (35%) of 20 patients with suprainguinal venous thrombus (P = .0422, compared with patients without suprainguinal venous thrombus), and six (46.2%) of 13 patients with malignancy and suprainguinal venous thrombus (P = .0091, compared with patients without malignancy or suprainguinal venous thrombus).


CONCLUSIONS
The data indicate that for some patients with malignancy or suprainguinal venous thrombus, insertion of an IVC filter gives little or no survival benefit. A reassessment of IVC filter use in these patients is warranted.
Rosen
M P
MP
Department of Radiology, Beth Israel Hospital, Harvard Medical School, Boston, MA 02215.
Porter
D H
DH
Kim
D
D
D000368:Aged; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality*; D011655:Pulmonary Embolism / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013924:Thrombophlebitis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016306:Vena Cava Filters / Q000706:statistics & numerical data*