title: Reporting the impact of inferior vena cava perforation by filters.
abstract: BACKGROUND
  Perforation of the inferior vena cava by filters struts is a known complication. The goal of our review is to assess the impact of inferior vena cava perforation by filters based on an open, voluntary national database.
  
  
  METHODS
  We reviewed 3311 adverse events of inferior vena cava filters reported in Manufacturer and User Facility Device Experience database from January 2000 to June 2011. Outcomes of interest were incidence of inferior vena cava perforation, type of filter, clinical presentation, and management of the perforation, including retrievability rates.
  
  
  RESULTS
  Three hundred ninety-one (12%) cases of inferior vena cava perforation were reported. The annual distribution of inferior vena cava perforation was 35 cases (9%), varying from seven (2%) to 70 (18%). A three-fold increment in the number of adverse events related to inferior vena cava filters has been noted since 2004. Wall perforation as an incidental finding was the most common presentation (N = 268, 69%). Surrounding organ involvement was found in 117 cases (30%), with the aorta being the most common in 43 cases (37%), followed by small bowel in 36 (31%). Filters were retrieved in 97 patients (83%) regardless of wall perforation. Twenty-five (26%) cases required an open procedure to remove the filter. Neither major bleeding requiring further intervention nor mortality was reported.
  
  
  CONCLUSIONS
  Inferior vena cava perforation by filters remains stable over the studied years despite increasing numbers of adverse events reported. The majority of filters involved in a perforation were retrievable. Filter retrieval, regardless of inferior vena cava wall perforation, is feasible and must be attempted whenever possible in order to avoid complications.
authors.affiliation: Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Wood
authors.affiliation: Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA rafael.malgor@stonybrook.edu.
authors.forename: Rafael D
authors.initials: RD
authors.lastname: Malgor
authors.affiliation: Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Antonios P
authors.initials: AP
authors.lastname: Gasparis
authors.affiliation: Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Nicos
authors.initials: N
authors.lastname: Labropoulos
mesh_terms: D016208:Databases, Factual; D020878:Device Removal / Q000379:methods; D006801:Humans; D015994:Incidence; D011474:Prosthesis Design; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D057772:Vascular System Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016306:Vena Cava Filters / Q000009:adverse effects*; D014682:Vena Cava, Inferior / Q000293:injuries* / Q000601:surgery
keywords: Inferior vena cava; deep vein thrombosis; filter; pulmonary embolism