title: A quality improvement project to improve inferior vena cava filter retrieval.
abstract: Poor retrieval rates for retrievable inferior vena cava filters (R-IVCFs) have been reported throughout the literature, with poor follow-up a common cause. In 2009, we reported a retrieval rate of 18% despite an initial follow-up rate of 85%. Use of a registry has been shown to improve retrieval rates. As a quality improvement project, in May 2012, the vascular surgery fellowship implemented a reiterative registry to track R-IVCFs placed at Walter Reed National Military Medical Center to improve retrieval rates. We report the results in 125 patients after 38 months.
  
  
  
  Patients receiving an R-IVCF were entered into a registry. All patients were reviewed monthly using an electronic health record. When there was no longer an indication for the R-IVCF, the patient was scheduled for an outpatient appointment with a vascular surgeon followed by retrieval. Rates of retrieval, technical success, dwell time, indication, complications, and demographics were collected.
  
  
  
  There were 125 R-IVCFs placed between May 2012 and June 2015; 52 filters were placed for therapeutic and 73 for prophylactic indications. Our follow-up rate improved to 94%. A total of 79 filters were retrieved (63% absolute retrieval rate). Excluding patients who died before retrieval and patients with a permanent indication, 77% of filters were retrieved. The average dwell time was 101.5 days (7-460 days), and 63% of successful R-IVCF retrievals were within 3 months of placement. Technical success for retrieval was 92%. There were two major complications from retrievals (1.5% of retrievals).
  
  
  
  The creation of an R-IVCF registry promoted ongoing follow-up with patients. In our earlier experience, retrieval rates were poor despite a high follow-up rate. The use of a reiterative registry improved our retrieval rate by 45% and increased our follow-up rate to 94%. These results emphasize the importance of repetitive follow-up for R-IVCFs. Despite a follow-up rate >90%, around a third of R-IVCFs were not retrieved.
authors.affiliation: Vascular Surgery Service, Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Simon
authors.affiliation: Vascular Surgery Service, Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md.
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Walker
authors.affiliation: Vascular Surgery Service, Department of Surgery, Madigan Army Medical Center, Tacoma, Wash.
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Daab
authors.affiliation: Vascular Surgery Service, Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: White
authors.affiliation: Vascular Surgery Service, Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md. Electronic address: paul.w.white4.mil@mail.mil.
authors.forename: Paul W
authors.initials: PW
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D008396:Maryland; D008875:Middle Aged; D011475:Prosthesis Failure; D058996:Quality Improvement / Q000458:organization & administration*; D012042:Registries; D016306:Vena Cava Filters