The use of retrievable inferior vena cava filters in severely injured military trauma patients.
OBJECTIVE
Important recent data on retrievable inferior vena cava filter (R-IVCF) used in civilian trauma centers suffer from poor follow-up in these transient patients. Because US military casualties can be more easily followed globally, our objective was to further characterize R-IVCF outcomes in a trauma population with improved follow-up.


METHODS
From July 2003 to June 2007, trauma registry records were retrospectively reviewed for US soldiers injured in Iraq and Afghanistan who had R-IVCF placement. Indications, type of filter, complications, outcomes, and retrieval data were analyzed.


RESULTS
Seventy-two R-IVCFs were placed during the study period. Mean follow-up was 28.0 +/- 12.0 months, in 61 (85%) patients. Mean injury severity score (ISS) was 36.3 +/- 10.4 and mean patient age was 27.4 +/- 6.4 years. Fifty-nine R-IVCFs (82%) were not retrieved due to: death (1, 1.3%), technical failure (2, 2.8%), lost to follow-up (11, 15.2%), or contraindications to retrieval (45, 62.5%). Thirteen R-IVCFs were successfully removed, an overall retrieval rate of 18%. Median dwell time of those removed was 47 days (range, 10-94). IVCF indications were prophylactic in 23 (32%) and therapeutic in 49 (68%) cases. Both retrieval failures were due to incorporation into the caval wall, attempted at 90 and 156 days. Deep vein thromboses at the insertion site or pulmonary embolism following R-IVCF placement or removal were not observed. To date, there have been no reports of IVC stenosis or occlusion.


CONCLUSIONS
R-IVCFs were safely and effectively used in severely injured military trauma patients with high ISS. Despite improved follow-up, overall retrieval remained low, reflecting the civilian experience. Indication, rather than follow-up losses, accounted for the low retrieval rate. Practice patterns for R-IVCF in trauma may need to be re-examined to optimize outcomes.
Johnson
Owen N
ON
Department of Surgery, Peripheral Vascular Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307, USA. Owen.Johnson@amedd.army.mil
Gillespie
David L
DL
Aidinian
Gilbert
G
White
Paul W
PW
Adams
Eric
E
Fox
Charles J
CJ
D000328:Adult; D055826:Afghan Campaign 2001-; D001808:Blood Vessels / Q000293:injuries*; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D010690:Phlebography; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult