Practice patterns and outcomes of retrievable vena cava filters in trauma patients: an AAST multicenter study.
BACKGROUND
The purpose of this study is to describe practice patterns and outcomes of posttraumatic retrievable inferior vena caval filters (R-IVCF).


METHODS
A retrospective review of R-IVCFs placed during 2004 at 21 participating centers with follow up to July 1, 2005 was performed. Primary outcomes included major complications (migration, pulmonary embolism [PE], and symptomatic caval occlusion) and reasons for failure to retrieve.


RESULTS
Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% for prophylactic indications and 79% were placed by interventional radiology. Excluding 33 deaths, 152 were Gunter-Tulip (G-T), 224 Recovery (R), and 37 Optease (Opt). Placement occurred 6 +/- 8 days after admission and retrieval at 50 +/- 61 days. Follow up after discharge (5.7 +/- 4.3 months) was reported in 51%. Only 22% of R-IVCFs were retrieved. Of 115 patients in whom retrieval was attempted, retrieval failed as a result of technical issues in 15 patients (10% of G-T, 14% of R, 27% of Opt) and because of significant residual thrombus within the filter in 10 patients (6% of G-T, 4% of R, 46% Opt). The primary reason R-IVCFs were not removed was because of loss to follow up (31%), which was sixfold higher (6% to 44%, p = 0.001) when the service placing the R-IVCF was not directly responsible for follow up. Complications did not correlate with mechanism, injury severity, service placing the R-IVCF, trauma volume, use of anticoagulation, age, or sex. Three cases of migration were recorded (all among R, 1.3%), two breakthrough PE (G-T 0.6% and R 0.4%) and six symptomatic caval occlusions (G-T 0, R 1%, Opt 11%) (p < 0.05 Opt versus both G-T and R).


CONCLUSIONS
Most R-IVCFs are not retrieved. The service placing the R-IVCF should be responsible for follow up. The Optease was associated with the greatest incidence of residual thrombus and symptomatic caval occlusion. The practice patterns of R-IVCF placement and retrieval should be re-examined.
Karmy-Jones
Riyad
R
Harborview Medical Center, Seattle, WA, USA. rkarmyjo@swmedicalcenter.com
Jurkovich
Gregory J
GJ
Velmahos
George C
GC
Burdick
Thomas
T
Spaniolas
Konstantinos
K
Todd
Samuel R
SR
McNally
Michael
M
Jacoby
Robert C
RC
Link
Daniel
D
Janczyk
Randy J
RJ
Ivascu
Felicia A
FA
McCann
Michael
M
Obeid
Farouck
F
Hoff
William S
WS
McQuay
Nathaniel
N
Tieu
Brandon H
BH
Schreiber
Martin A
MA
Nirula
Ram
R
Brasel
Karen
K
Dunn
Julie A
JA
Gambrell
Debbie
D
Huckfeldt
Roger
R
Harper
Jayna
J
Schaffer
Kathryn B
KB
Tominaga
Gail T
GT
Vinces
Fausto Y
FY
Sperling
David
D
Hoyt
David
D
Coimbra
Raul
R
Rosengart
Mathew R
MR
Forsythe
Raquel
R
Cothren
Clay
C
Moore
Ernest E
EE
Haut
Elliott R
ER
Hayanga
Awori J
AJ
Hird
Linda
L
White
Christopher
C
Grossman
Jodi
J
Nagy
Kimberly
K
Livaudais
West
W
Wood
Rhonda
R
Zengerink
Imme
I
Kortbeek
John B
JB
D000328:Adult; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016306:Vena Cava Filters / Q000009:adverse effects / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000150:complications / Q000601:surgery*