title: Optimizing IVC filter utilization: a prospective study of the impact of interventional radiologist consultation.
abstract: OBJECTIVE
  The use of inferior vena cava filters (IVCFs) is under increasing scrutiny because of device safety and economic considerations. The aim of this study was to test the hypothesis that interventional radiologist (IR) consultation results in better utilization of optional and permanent filters.
  
  
  METHODS
  Over 6 months, an IVCF decision-making database at a single institution was prospectively studied. After IR consultation, each case was classified as concordant (agreement between the referring physician and the IR over filter choice) or discordant (disagreement over filter choice). The consulting IR estimated the likelihood of retrieval attempt for all optional filters at the time of placement (0%-100%). Chi-square and t tests were used for statistical analyses. The null hypotheses were rejected at P < .05.
  
  
  RESULTS
  Sixty-six IVCFs (23 permanent, 43 optional) were placed in 66 patients. Sixteen of 66 decisions were discordant. In 7 of the 16 discordant cases, patients received optional filters; of these, 6 (86%) were declared permanent by the referring physician. For this group, the IR's prospective estimate of subsequent retrieval was 6.4% (0%-15%; P < .001). Fifty of 66 decisions were concordant. Of these, 36 patients received optional filters. Thirty-one of 36 concordant optional filters (86%) were successfully retrieved (P < .001). For this group, the IR's prospective estimate of subsequent retrieval was 88.3% (80%-100%; P < .001). Of the 5 concordant devices not retrieved, 2 patients died, and 3 devices were declared permanent. There were no IVCF placement or retrieval failures. No patients were lost to follow-up.
  
  
  CONCLUSIONS
  Interventional radiologists can prospectively predict the likelihood of optional filter retrieval. Significantly higher retrieval rates are achieved as a result of IR consultation. Interventional radiologist consultation positively affects IVCF device choice, patient safety, and effective utilization.
authors.affiliation: Section of Interventional Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60614, USA. rryu@nmff.org
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Pankit
authors.initials: P
authors.lastname: Parikh
authors.forename: Ramona
authors.initials: R
authors.lastname: Gupta
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Eifler
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
mesh_terms: D016009:Chi-Square Distribution; D003657:Decision Making; D020878:Device Removal; D006801:Humans; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000517:prevention & control*; D015642:Radiology, Interventional / Q000592:standards*; D012017:Referral and Consultation; D016306:Vena Cava Filters / Q000706:statistics & numerical data*