title: Early Placement of Optional Vena Cava Filter in High-Risk Patients with Traumatic Brain Injury.
abstract: OBJECTIVE
  Patients sustaining severe trauma are at high risk for the development of venous thromboembolic events (VTE). Pharmacologic VTE prophylaxis may be contraindicated early after trauma due to potential bleeding complications. The purpose of this study was to evaluate safety and feasibility of early prophylactic vena cava filter (VCF) placement and subsequent retrieval in multiple injured patients with traumatic brain injury (TBI).
  
  
  METHODS
  Analysis of single-institution case series of consecutive patients who received a prophylactic VCF after severe TBI (Abbreviated Injury Scale, AiS ≥ 3) between August 2003 and October 2006.
  
  
  RESULTS
  A total of 34 optional VCF were prophylactically placed with a median delay of 1 day after trauma (range, 0-7 days). All patients had sustained multiple injuries (median Injury Severity Score 41, range, 18-59) with severe TBI (median AiS 4, range 3-5). Median age was 41 years (range, 17-67 years). Two patients had succumbed before potential filter retrieval. Of the remaining patients, 27 (84%) had their filters uneventfully retrieved between 11 and 32 days (median, 18 days) after placement with no retrieval-related morbidity. Five VCF (16%) were left permanently. In one patient (3%) early inferior vena cava occlusion and deep venous thrombosis occurred 14 days after VCF placement. Symptomatic pulmonary embolism was observed in one patient (3%) 5 days after VCF retrieval. Overall trauma-related mortality was 9%.
  
  
  CONCLUSIONS
  Early VCF placement may be of benefit for multiple injured patients with TBI when pharmacologic VTE prophylaxis is contraindicated. VCF retrieval is safe and feasible. Filter placement- and retrieval-related morbidity is low.
authors.affiliation: Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland. meierpucillo@hispeed.ch.|Division of Trauma Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. meierpucillo@hispeed.ch.
authors.forename: Christoph
authors.initials: C
authors.lastname: Meier
authors.affiliation: Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfammatter
authors.affiliation: Division of Surgical Intensive Care, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Stocker
authors.affiliation: Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Labler
authors.affiliation: Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Benninger
authors.affiliation: Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lenzlinger
authors.affiliation: Division of Surgical Intensive Care, University Hospital Zurich, Zurich, Switzerland.
authors.forename: John
authors.initials: J
authors.lastname: Stover
authors.affiliation: Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Otmar
authors.initials: O
authors.lastname: Trentz
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Hans G
authors.initials: HG
authors.lastname: Imhof
keywords: Multiple Trauma; Optional vena cava filter; VTE prophylaxis; Vena cava filter retrieval; traumatic brain injury