title: Caval Penetration by Inferior Vena Cava Filters: A Systematic Literature Review of Clinical Significance and Management.
abstract: BACKGROUND
  Limited penetration into the caval wall is an important securing mechanism for inferior vena cava (IVC) filters; however, caval penetration can also cause unintentional complications. The aim of this study was to assess the incidence, severity, clinical consequences, and management of filter penetration across a range of commercially available IVC filters.
  
  
  RESULTS
  The MEDLINE database was searched for all studies (1970-2014) related to IVC filters. A total of 88 clinical studies and 112 case reports qualified for analysis; these studies included 9002 patients and 15 types of IVC filters. Overall, penetration was reported in 19% of patients (1699 of 9002), and 19% of those penetrations (322 of 1699) showed evidence of organ/structure involvement. Among patients with penetration, 8% were symptomatic, 45% were asymptomatic, and 47% had unknown symptomatology. The most frequently reported symptom was pain (77%, 108 of 140). Major complications were reported in 83 patients (5%). These complications required interventions including surgical removal of the IVC filter (n=63), endovascular stent placement or embolization (n=11), endovascular retrieval of the permanent filter (n=4), and percutaneous nephrostomy or ureteral stent placement (n=3). Complications led to death in 2 patients. A total of 87% of patients (127 of 146) underwent premature filter retrieval or interventions for underlying symptoms or penetration-related complications.
  
  
  CONCLUSIONS
  Caval penetration is a frequent but clinically underrecognized complication of IVC filter placement. Symptomatic patients accounted for nearly 1/10th of all penetrations; most of these cases had organ/structure involvement. Interventions with endovascular retrieval and surgery were required in most of these symptomatic patients.
authors.affiliation: From Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.).
authors.forename: Zhongzhi
authors.initials: Z
authors.lastname: Jia
authors.affiliation: From Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.).
authors.forename: Alex
authors.initials: A
authors.lastname: Wu
authors.affiliation: From Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.).
authors.forename: Mathew
authors.initials: M
authors.lastname: Tam
authors.affiliation: From Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.).
authors.forename: James
authors.initials: J
authors.lastname: Spain
authors.affiliation: From Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.).
authors.forename: J Mark
authors.initials: JM
authors.lastname: McKinney
authors.affiliation: From Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.). Wang.Weiping@mayo.edu.
authors.forename: Weiping
authors.initials: W
authors.lastname: Wang
mesh_terms: D020878:Device Removal / Q000379:methods* / Q000592:standards; D019468:Disease Management; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D011474:Prosthesis Design / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016306:Vena Cava Filters / Q000009:adverse effects*; D014682:Vena Cava, Inferior / Q000293:injuries* / Q000601:surgery
keywords: complications; embolic protection devices; vena cava filters; vena cava, inferior