title: Risk factors of nonretrieval of retrievable inferior vena cava filters.
abstract: BACKGROUND
  Optimal use of retrievable inferior vena cava (IVC) filters is an important health care issue, and despite an exponential rise in the use of retrievable IVC filters, national trends suggest that most of these filters are not removed. The purpose of this study was to identify risk factors associated with nonretrieval of retrievable IVC filters at our institution.
  
  
  METHODS
  A retrospective institutional review of all patients undergoing IVC filter placement from June 2010 to June 2012 was performed. A number of patient parameters were studied, including relevant demographics, indication for filter placement, clinical history, related hospitalization, and whether filter retrieval was performed. Patient parameters were compared by univariate and multivariate logistic regression analyses.
  
  
  RESULTS
  There were 605 retrievable IVC filters placed over a 24-month period by vascular surgery, intervention radiology, and interventional cardiology. The follow-up retrieval rate was 25%. By indication, 272 (45%), 53 (9%), and 280 (46%) filters were placed for absolute, relative, and prophylactic indications, respectively. Independent predictors for nonretrieval by multivariate analysis were age >80 years (hazard ratio [HR], 5.0; 95% confidence interval [CI], 1.7-20; P < 0.001), acute bleed (HR, 2.5; 95% CI, 1.4-5; P < 0.001), current malignancy (HR, 2.0; 95% CI, 1.3-3.3; P = 0.011), postfilter anticoagulation (HR, 0.5; 95% CI, 0.28-0.9; P = 0.017), and history of pulmonary embolism and/or venous thromboembolism (HR, 0.5; 95% CI, 0.28-0.35; P < 0.001). Filter placement team and indication were not identified as independent predictors of nonretrieval of IVC filters.
  
  
  CONCLUSIONS
  Patient variables identified by univariate and multivariate analyses as risk for nonretrieval of retrievable IVC filters have several implications: first, some of these patients may represent a group of patients with a low life expectancy or unresolvable underlying condition in which filter retrieval has diminishing returns and may indicate the clinical option for permanence of the filter; second, identification of risk factors for nonretrieval in patients before filter placement will help to optimize use of retrievable IVC filters and enhance retrieval rates.
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY. Electronic address: jeffrey.siracuse@bmc.org.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Siracuse
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Bazroon
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gill
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Meltzer
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Darren B
authors.initials: DB
authors.lastname: Schneider
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Inkyong
authors.initials: I
authors.lastname: Parrack
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Jones
authors.affiliation: Division of Vascular and Endovascular Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Connolly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016208:Databases, Factual; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D018579:Patient Selection; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000009:adverse effects*