title: Inferior vena cava filter placement in the gynecologic oncology patient: A 15-year institutional experience.
abstract: OBJECTIVE
  Venous thrombosis is a frequent complication of gynecologic cancer. Data regarding the use of inferior vena cava (IVC) filters in this population is limited. The aim of this study was to review our experience with gynecologic oncology patients who received an IVC filter, specifically to evaluate indications for filter placement and survival outcomes.
  
  
  METHODS
  This was a retrospective, single-institution study of patients who had an IVC filter placed after a histologically confirmed gynecologic malignancy. Patients were identified from a prospectively collected interventional radiology (IR) database. Clinicopathologic characteristics, procedure details, and outcome data were obtained from outpatient and inpatient medical records. Survival after IVC filter placement was analyzed using the Kaplan-Meier product limit method and compared by log-rank test.
  
  
  RESULTS
  A total of 128 patients were identified and 103 were found to be eligible for analysis. Most patients had ovarian cancer (52%), followed by cervical cancer (25%) and endometrial cancer (21%). Two-thirds had advanced stage disease (III/IV). The procedure complication rate was 2%. Median survival after IVC filter placement was 7.8months (95% CI, 4.1-13.6). The most common indication for IVC filter placement was contraindication to anticoagulation secondary to hemorrhage (44%), followed by perioperative indications (30%) and failed anticoagulation (14%). There was no difference in survival by IVC filter placement indication (p=0.18). The majority of the IVC filters placed were permanent (90.5%) and in an infrarenal position (95.8%). There was no difference in survival according to specific thromboembolic event (DVT vs. PE vs. both). Patients able to receive anticoagulation after IVC filter placement had improved survival (HR 0.45, 95%CI 0.45-0.27, p=0.003).
  
  
  CONCLUSIONS
  We present the largest series of gynecologic oncology patients treated with IVC filters. Long-term survival after IVC filter placement is uncommon. Patients who receive anticoagulation after IVC filter placement have an improved survival over those who do not receive anticoagulation; this difference in survival may be secondary to worsening disease causing contraindications to anticoagulation.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO 63110, USA. dewdneys@wustl.edu
authors.forename: Summer B
authors.initials: SB
authors.lastname: Dewdney
authors.forename: Teri
authors.initials: T
authors.lastname: Benn
authors.forename: B J
authors.initials: BJ
authors.lastname: Rimel
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Nael
authors.initials: N
authors.lastname: Saad
authors.forename: Suresh
authors.initials: S
authors.lastname: Vedantham
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Israel
authors.initials: I
authors.lastname: Zighelboim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D016306:Vena Cava Filters; D055815:Young Adult