Caval filters in intensive care: a retrospective study.
OBJECTIVE
To evaluate the effectiveness of a caval vein filter (CVF) peri-implant monitoring protocol in order to reduce pulmonary embolism (PE) mortality and CVF-related morbidity.


BACKGROUND
The reduction in mortality from PE associated with the use of CVF is affected by the risk of increase in morbidity. Therefore, CVF implant is a challenging prophylactic or therapeutic option. Nowadays, we have many different devices whose rational use, by applying a strict peri-implant monitoring protocol, could be safe and effective.


METHODS
We retrospectively studied 62 patients of a general Intensive Care Unit (ICU) scheduled for definitive, temporary, or optional bedside CVF implant. A peri-implant monitoring protocol including a phlebocavography, an echo-Doppler examination, and coagulation tests was adopted.


RESULTS
In our study, no thromboembolic recurrence was registered. We implanted 48 retrievable and only 20 definitive CVFs. Endothelial adhesion (18%), residual clot (5%), cranial or caudal migration (6%), microbial colonization of the filter in the absence of clinical signs of infection (1%), caval thrombosis (1%), and pneumothorax (1%) were reported. Deep-vein thrombosis (DVT) was reported (8%) as early complication. All patients with DVT had a temporary or optional filter implanted. However, in our cohort, definitive CVFs were reserved only to 32% of patients and they were not associated with DVT as complication.


CONCLUSIONS
CVF significantly reduces iatrogenic PE without affecting mortality. Generally, ICU patients have a transitory thromboembolic risk, and so the temporary CVF has been proved to be a first-line option to our cohort. A careful monitoring may contribute to a satisfactory outcome in order to promote CVF implant as a safe prophylaxis option.
Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy.
F
F
Ferraro
Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy.
T L
TL
Di Gennaro
Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy.
A
A
Torino
Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy.
J
J
Petruzzi
Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy.
A
A
d'Elia
Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy.
P
P
Fusco
Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy.
R
R
Marfella
Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy.
B
B
Lettieri
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000150:complications; D055815:Young Adult
caval vein filter; pulmonary embolism; thromboembolic disease