Retrievable Inferior Vena Cava Filters in Trauma Patients: Prevalence and Management of Thrombus Within the Filter.
OBJECTIVE
The incidence of thrombus was investigated within retrievable filters placed in trauma patients with confirmed DVT at the time of retrieval and the optimal treatment for this clinical scenario was assessed. A technique called "filter retrieval with manual negative pressure aspiration thrombectomy" for management of filter thrombus was introduced and assessed.


METHODS
The retrievable filters referred for retrieval between January 2008 and December 2015 were retrospectively reviewed to determine the incidence of filter thrombus on a pre-retrieval cavogram. The clinical outcomes of different managements for thrombus within filters were recorded and analyzed.


RESULTS
During the study 764 patients having Aegisy Filters implanted were referred for filter removal, from which 236 cases (134 male patients, mean age 50.2 years) of thrombus within the filter were observed on initial pre-retrieval IVC venogram 12-39 days after insertion (average 16.9 days). The incidence of infra-filter thrombus was 30.9%, and complete occlusion of the filter bearing IVC was seen in 2.4% (18) of cases. Retrieval was attempted in all 121 cases with small clots using a regular snare and sheath technique, and was successful in 120. A total of 116 cases with massive thrombus and IVC occlusion by thrombus were treated by CDT and/or the new retrieval technique. Overall, 213 cases (90.3%) of thrombus in the filter were removed successfully without PE.


CONCLUSIONS
A small thrombus within the filter can be safely removed without additional management. CDT for reduction of the clot burden in filters was effective and safe. Filter retrieval with manual negative pressure aspiration thrombectomy seemed reasonable and valuable for management of massive thrombus within filters in some patients. Full assessment of the value and safety of this technique requires additional studies.
Vascular Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, China.
Y
Y
Pan
Vascular Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, China. Electronic address: junnzhao@126.com.
J
J
Zhao
Vascular Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, China.
J
J
Mei
Vascular Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, China.
M
M
Shao
Vascular Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, China.
J
J
Zhang
Vascular Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, China.
H
H
Wu
D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D020878:Device Removal / Q000009:adverse effects; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000009:adverse effects*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
Caval filters; Deep vein thrombosis; Pulmonary embolism; Thrombolysis; Trauma