Pulmonary embolism from upper extremity deep vein thrombosis and the role of superior vena cava filters: a review of the literature.
The placement of superior vena cava (SVC) filters to prevent pulmonary emboli (PE) from upper-extremity deep vein thrombosis (UEDVT), although controversial, has been reported. A total of 21 publications were identified that reported 209 SVC filters and documented eight major filter-related complications (3.8%), including four cardiac tamponades, two aortic perforations, and one recurrent pneumothorax. The in-hospital or 1-month mortality rate was 43.1%. Twenty-eight additional publications were identified that reported 3,747 cases of UEDVT. The rates of PE and associated mortality were 5.6% and 0.7%, respectively. Studies imaging both upper and lower extremities found deep vein thrombus 14.7 times more likely to occur in the lower extremities and the rate of PE from a lower-extremity thrombus to be 25.1%. The lack of evidence documenting the risk from UEDVT and the absence of data supporting the safety and efficacy of SVC filters bring their benefit into question.
Owens
Charles A
CA
Division of Interventional Radiology, University of Illinois Medical Center, M/C 931, 1740 West Taylor Street, Chicago, IL 60612, USA. cowens@uic.edu
Bui
James T
JT
Knuttinen
M Grace
MG
Gaba
Ron C
RC
Carrillo
Tami C
TC
D006801:Humans; D015994:Incidence; D011655:Pulmonary Embolism / Q000401:mortality* / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016306:Vena Cava Filters / Q000706:statistics & numerical data*; D014683:Vena Cava, Superior / Q000601:surgery*; D020246:Venous Thrombosis / Q000401:mortality* / Q000601:surgery*