Reference
Reference
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1. Wells PS, Forgie MA, Rodger MA. Treatment of venous thromboembolism. JAMA. 2014;311(7):717-728. Review/Other-Tx N/A To review the etiology of venous thromboembolism (VTE) and the 3 phases of VTE treatment: acute (first 5-10 days), long-term (from end of acute treatment to 3-6 months), and extended (beyond 3-6 months). Low-molecular-weight heparin (LMWH) along with with vitamin K antagonists and the benefits and proven safety of ambulation have allowed for outpatient management of most cases of deep vein thrombosis (DVT) in the acute phase. Development of new oral anticoagulants further simplifies acute-phase treatment and 2 oral agents can be used as monotherapy, avoiding the need for LMWH. Patients with pulmonary embolism (PE) can also be treated in the acute phase as outpatients, a decision dependent on prognosis and severity of PE. Thrombolysis is best reserved for severe VTE; inferior vena cava filters, ideally the retrievable variety, should be used when anticoagulation is contraindicated. In general, DVT and PE patients require 3 months of treatment with anticoagulants, with options including LMWH, vitamin K antagonists, or direct factor Xa or direct factor IIa inhibitors. After this time, decisions for further treatment are based on balancing the risk of VTE recurrence, determined by etiology of the VTE (transient risk factors, unprovoked or malignancy associated), against the risk of major hemorrhage from treatment. Better prediction tools for major hemorrhage are needed. Experience with new oral anticoagulants as acute, long-term, and extended therapy options is limited as yet, but as a class they appear to be safe and effective for all phases of treatment. 4
2. Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387-394. Review/Other-Tx 68,183 patients To utilize the 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines to assess venous thromboembolism (VTE) risk and to determine whether patients were receiving recommended prophylaxis. A large proportion of hospitalised patients are at risk for VTE, but there is a low rate of appropriate prophylaxis. Our data reinforce the rationale for the use of hospital-wide strategies to assess patients’ VTE risk and to implement measures that ensure that at-risk patients receive appropriate prophylaxis. 4
3. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 149(2):315-352, 2016 Feb. Review/Other-Tx N/A To provide recommendations for the use of antithrombotic agents as well as the use of devices or surgical techniques in the treatment of patients with DVT and pulmonary embolism (PE), which are collectively referred to as VTE. For VTE and no cancer, as long-term anticoagulant therapy, we suggest dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B), or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over low-molecular-weight heparin (LMWH; Grade 2C). For VTE and cancer, we suggest LMWH over VKA (Grade 2B), dabigatran (Grade 2C), rivaroxaban (Grade 2C), apixaban (Grade 2C), or edoxaban (Grade 2C). We have not changed recommendations for who should stop anticoagulation at 3 months or receive extended therapy. For VTE treated with anticoagulants, we recommend against an inferior vena cava filter (Grade 1B). For DVT, we suggest not using compression stockings routinely to prevent PTS (Grade 2B). For subsegmental pulmonary embolism and no proximal DVT, we suggest clinical surveillance over anticoagulation with a low risk of recurrent VTE (Grade 2C), and anticoagulation over clinical surveillance with a high risk (Grade 2C). We suggest thrombolytic therapy for pulmonary embolism with hypotension (Grade 2B), and systemic therapy over catheter-directed thrombolysis (Grade 2C). For recurrent VTE on a non-LMWH anticoagulant, we suggest LMWH (Grade 2C); for recurrent VTE on LMWH, we suggest increasing the LMWH dose (Grade 2C). 4
4. Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008;358(10):1037-1052. Review/Other-Tx N/A To review the pathogenesis, diagnosis, and treatment of acute pulmonary embolism of thrombotic origin. No results stated in abstract. 4
5. Wang SL, Lloyd AJ. Clinical review: inferior vena cava filters (IVCF) in the age of patient-centered outcomes. Ann Med. 2013;45(7):474-481. Review/Other-Tx N/A To comprehensively examine the randomized, prospective data on inferior vena cava filter efficacy, compare relative rates of IVCF placement in the US and Europe, compare commonly considered guidelines for IVCF indications, and the current data on IVCF complications. No evidence has shown a survival benefit with IVCF use. Despite this, continued rising utilization, especially for primary prophylactic indications, is concerning, given increasing evidence of long-term filter-related complications. This is particularly noted in the US where IVCF placements for 2012 are projected to be 25 times that of an equivalent population in Europe (224,700 versus 9,070). 4
6. Young T, Tang H, Hughes R. Vena caval filters for the prevention of pulmonary embolism. Cochrane Database Syst Rev 2010:CD006212. Review/Other-Tx 529 patients To examine evidence for the effectiveness of (vena caval filters) VCFs in preventing pulmonary embolism (PE). Secondary outcomes were mortality, distal (to filter) thrombosis, and filter-related complications. Two studies were included involving a total of 529 people. One open quasi-randomised trial of 129 participants with traumatic hip fractures showed a reduction in PE but not mortality over a 34 day period in the filter group. The PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) trial, was an open RCT of 400 participants with documented proximal deep vein thrombosis (DVT) or PE who received concurrent anticoagulation. Permanent VCFs prevented PE at eight years. No reduction in mortality was seen, but this reflected an older study population; the majority of deaths were due to cancer or cardiovascular causes. There was an increased incidence of (DVT) in the filter group. Adverse events were not reported. 4
7. Uberoi R, Tapping CR, Chalmers N, Allgar V. British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry. Cardiovasc Intervent Radiol. 2013;36(6):1548-1561. Review/Other-Tx 1,434 IVC placements; 400 retrievals To provide an audit of current United Kingdom (UK) practice regarding placement and retrieval of IVC filters to address concerns regarding their safety. IVC filter use in the majority of patients in the UK follows accepted CIRSE guidelines. Filter placement is usually a low-risk procedure, with a low major complication rate ( < 0.5 %). Cook Gunther Tulip (560 filters: 39 %) and Celect (359 filters: 25 %) filters constituted the majority of IVC filters inserted, with Bard G2, Recovery filters, Cordis Trapease, and OptEase constituting most of the remainder (445 filters: 31 %). More than 96 % of IVC filters deployed as intended. Operator inexperience (< 25 procedure) was significantly associated with complications (p < 0.001). Of the IVC filters initially intended for temporary placement, retrieval was attempted in 78 %. Of these retrieval was technically successful in 83 %. Successful retrieval was significantly reduced for implants left in situ for < 9 weeks versus those with a shorter dwell time. New lower limb deep vein thrombosis (DVT) and/or IVC thrombosis was reported in 88 patients following filter placement, there was no significant difference of incidence between filter types. 4
8. Eifler AC, Lewandowski RJ, Gupta R, et al. Optional or permanent: clinical factors that optimize inferior vena cava filter utilization. J Vasc Interv Radiol. 2013;24(1):35-40. Observational-Tx N/A; To test the hypothesis that patient parameters identifiable at the time of inferior vena cava (IVC) filter placement can be used to predict the need for a permanent versus optional filter. A total of 265 optional IVC filters were placed and analyzed; 167 were removed and 98 were kept permanent. In the multivariable model predicting filter disposition, significant factors associated with permanence were age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05), male sex (OR, 3.01; 95% CI, 1.64-5.54), underlying malignancy (OR, 3.27; 95% CI, 1.77-6.03), and an indication of anticoagulation failure (OR, 8.12; 95% CI, 1.83-36.0). Significant factors associated with removal were history of VTE (OR, 0.39; 95% CI, 0.21-0.74), prophylactic filter placement indication (OR, 0.14; 95% CI, 0.04-0.43), and high-risk VTE (OR, 0.37; 95% CI, 0.15-0.94). The c-statistic for the prediction model based on these parameters was 0.80. 3
9. Vijay K, Hughes JA, Burdette AS, et al. Fractured Bard Recovery, G2, and G2 express inferior vena cava filters: incidence, clinical consequences, and outcomes of removal attempts. J Vasc Interv Radiol. 2012;23(2):188-194. Review/Other-Tx 548 patients; 63 fractured Recovery, G2, and G2 Express IVC filters were identified To increase the understanding of risks of inferior vena cava (IVC) filter fracture and embolization and the safety of removing fractured filters via retrospective review of a prospectively collected database of fractured IVC filters. A total of 63 fractured Recovery, G2, and G2 Express IVC filters were identified, for an overall fracture rate of 12%. Excluding foot process fractures, the fracture rate for only filter arms and/or legs was 6%. The incidence of fracture increased with longer filter dwell times. Success rates for removal of the nonfractured component (ie, main body) and fractured components (ie, arm or leg) were 98.4% and 53.4%, respectively. The distal embolization rate of fractured filter components was 13%. There were no immediate clinically significant complications associated with fracture component embolization or filter removal. A single patient was encountered with symptoms related to their fractured filter. 4
10. Weinberg I, Abtahian F, Debiasi R, et al. Effect of delayed inferior vena cava filter retrieval after early initiation of anticoagulation. Am J Cardiol. 2014;113(2):389-394. Observational-Tx 758 patients To determine patient characteristics, indications for IVCF (inferior vena cava filter) placement, retrieval rates, complications, and post-IVCF anticoagulation (AC) practices in patients who have received IVCFs. Seven hundred fifty-eight IVCFs were placed. Follow-up was available for 688 patients (90.7%) at a median of 342.0 days (interquartile range 81.5 to 758.0). Indications for IVCF placement included contraindication to AC in the presence of acute venous thromboembolism (n = 287 [41.7%]) and prophylaxis (n = 235 [34.2%]). Insertion-related complications occurred in 28 patients (4.1%). After IVCF placement, adequate AC was initiated in 454 patients (66.0%) <3.0 days (interquartile range 0 to 13.0) after insertion, but the overall retrieval rate was only 252 of 688 (36.6%) within a median of 134.0 days (interquartile range 72.50 to 205.8). Significant IVCF-related complications occurred in 122 patients (17.7%) within 32 days (interquartile range 13.0 to 116.8). The most common complication (72 of 131 [55.0%]) was deep vein thrombosis. 2
11. Morales JP, Li X, Irony TZ, Ibrahim NG, Moynahan M, Cavanaugh KJ, Jr. Decision analysis of retrievable inferior vena cava filters in patients without pulmonary embolism. J Vasc Surg Venous Lymphat Disord 2013;1:376-84. Review/Other-Tx N/A To weigh the risks and benefits of retrievable filter use as a function of the filter's time in situ. The net risk score reaches its minimum between day 29 and 54 postimplantation. This is consistent with an increasing net risk associated with continued use of retrievable IVC filters in patients with transient, reversible risk of PE. The results were insensitive to reasonable variations in the assessed weights and adverse event occurrence rates. 4
12. Angel LF, Tapson V, Galgon RE, Restrepo MI, Kaufman J. Systematic review of the use of retrievable inferior vena cava filters. J Vasc Interv Radiol. 2011;22(11):1522-1530 e1523. Review/Other-Tx 6,834 patients To review the available literature on retrievable inferior vena cava (IVC) filters to examine the effectiveness and risks of these devices. Eligibility criteria were met by 37 studies comprising 6,834 patients. All of the trials had limitations, and no studies were randomized. There were 11 prospective clinical trials; the rest were retrospective studies. Despite the limitations of the evidence, the IVC filters seemed to be effective in preventing pulmonary embolism (PE); the rate of PE after IVC placement was 1.7%. The mean retrieval rate was 34%. Most of the filters became permanent devices. Multiple complications associated with the use of IVC filters were described in the reviewed literature or were reported to the MAUDE database; most of these were associated with long-term use (> 30 days). At the present time, the objective comparison data of different filter designs do not support superiority of any particular design. 4
13. Montgomery JP, Kaufman JA. A Critical Review of Available Retrievable Inferior Vena Cava Filters and Future Directions. Semin Intervent Radiol. 2016;33(2):79-87. Review/Other-Tx N/A To discuss the different inferior vena cava filters designs as well as the published data on these available filters. When selecting a filter for use, it is important to consider the potential short-term complications and the filters' window for retrieval. We address research into new designs that may be the future of vena cava filtration. 4
14. Andreoli JM, Lewandowski RJ, Vogelzang RL, Ryu RK. Comparison of complication rates associated with permanent and retrievable inferior vena cava filters: a review of the MAUDE database. J Vasc Interv Radiol. 2014;25(8):1181-1185. Observational-Tx 1,057 IVC filters To compare the safety of permanent and retrievable inferior vena cava (IVC) filters by reviewing the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database. For the period January 2009-December 2012, 1,606 reported AEs involving 1,057 IVC filters were identified in the MAUDE database . Of reported AEs, 1,394 (86.8%) involved retrievable inferior vena cava filters (rIVCFs), and 212 (13.2%) involved permanent inferior vena cava filters (pIVCFs) (P < .0001). Reported AEs included fracture, migration, limb embolization, tilt, IVC penetration, venous thromboembolism and pulmonary embolism, IVC thrombus, and malfunctions during placement. Each specific AE was reported with significantly higher frequency in rIVCFs compared with pIVCFs. The most common reported complication with rIVCFs was fracture, whereas the most commonly reported complications with pIVCFs were placement malfunctions. For rIVCFs, the most commonly reported AE varied depending on filter brand. 3
15. Baadh AS, Zikria JF, Rivoli S, Graham RE, Javit D, Ansell JE. Indications for inferior vena cava filter placement: do physicians comply with guidelines? J Vasc Interv Radiol. 2012;23(8):989-995. Review/Other-Tx 499 filters placed in 26 month period To measure compliance with established guidelines, relationship of medical specialty to filter placement, and evaluation of self-referral patterns among physicians. Compliance with established ACCP guidelines was poor regardless of whether the IVC filter insertion was performed by interventional radiology (IR; 43.5%), vascular surgery (VS; 39.9%), or interventional cardiology (IC; 33.3%) staff. Compliance with the less restrictive SIR guidelines was better (77.5%, 77.1%, and 80% for IR, VS, and IC, respectively). There was a greater degree of guideline compliance when filter placement was recommended by internal medicine (IM)-trained physicians than by non-IM-trained physicians: 46.3% of IR-placed filters requested by IM physicians met ACCP criteria whereas only 24.0% of filters recommended by non-IM specialties were compliant with criteria (P = .03). In the VS group, these compliance rates were 45.8% and 31.5%, respectively (P = .03). Among IR-placed filters, 84.0% of IM-recommended filter placements were compliant with SIR guidelines, versus only 48.0% of non-IM-recommended placements (P </= .001). In the VS group, these compliance rates were 87.8% and 69.6%, respectively (P </= .001). 4
16. Sader RB, Friedman A, Berkowitz E, Martin E. Inferior vena cava filters and their varying compliance with the ACCP and the SIR guidelines. South Med J. 2014;107(9):585-590. Review/Other-Tx N/A To assess documented indications for IVC filter placement and evaluated compliance with standards set by the American College of Chest Physicians (ACCP) and the Society of Interventional Radiology (SIR). Compliance with established ACCP guidelines was poor regardless of whether the IVC filter insertion was performed by interventional radiology (IR; 43.5%), vascular surgery (VS; 39.9%), or interventional cardiology (IC; 33.3%) staff. Compliance with the less restrictive SIR guidelines was better (77.5%, 77.1%, and 80% for IR, VS, and IC, respectively). There was a greater degree of guideline compliance when filter placement was recommended by internal medicine (IM)-trained physicians than by non-IM-trained physicians: 46.3% of IR-placed filters requested by IM physicians met ACCP criteria whereas only 24.0% of filters recommended by non-IM specialties were compliant with criteria (P = .03). In the VS group, these compliance rates were 45.8% and 31.5%, respectively (P = .03). Among IR-placed filters, 84.0% of IM-recommended filter placements were compliant with SIR guidelines, versus only 48.0% of non-IM-recommended placements (P </= .001). In the VS group, these compliance rates were 87.8% and 69.6%, respectively (P </= .001). 4
17. White RH, Geraghty EM, Brunson A, et al. High variation between hospitals in vena cava filter use for venous thromboembolism. JAMA Intern Med. 2013;173(7):506-512. Review/Other-Tx 130,643 patients To compare the frequency of VCF use among California hospitals from January 1, 2006, through December 31, 2010. Among the 263 hospitals included, 130 643 acute VTE hospitalizations occurred with the placement of 19 537 VCFs (14.95%). Variation in the percentage of acute VTE hospitalizations that included VCF placement was very high, from 0% to 38.96% (interquartile range, 6.23%-18.14%), with 18.49% of the observed variation due to differences among the hospitals that provided care. Significant clinical predictors of VCF use included acute bleeding at the time of admission (odds ratio, 3.4 [95% CI, 3.2-3.6]), a major operation after admission for VTE (3.4 [3.3-3.5]), presence of metastatic cancer (1.7 [1.6-1.8]), and extreme severity of illness (2.5 [2.3-2.7] vs mild). Insertion of VCFs occurred more frequently than expected in 109 hospitals and less frequently in 59. Hospital characteristics associated with VCF use included a small number of beds (odds ratio, 0.2 [95% CI, 0.2-0.4], <100 vs >400 beds), a rural location (0.4 [0.2-0.5]), and other private vs Kaiser hospitals (1.5 [1.1-2.0]). Use of VCFs varied widely even in geographically proximate areas. 4
18. Kaufman JA, Kinney TB, Streiff MB, et al. Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference. J Vasc Interv Radiol. 2006;17(3):449-459. Review/Other-Tx N/A No abstract available. No abstract available. 4
19. Giannoudis PV, Pountos I, Pape HC, Patel JV. Safety and efficacy of vena cava filters in trauma patients. Injury. 2007;38(1):7-18. Review/Other-Tx N/A To review all the available data on inferior IVC (vena cava) filter placement in trauma patients and we discuss the potential complications of IVC filters in order to understand better the risk/benefit ratio of their use. No results stated in abstract. 4
20. Malinoski D, Ewing T, Patel MS, et al. Risk factors for venous thromboembolism in critically ill trauma patients who cannot receive chemical prophylaxis. Injury. 2013;44(1):80-85. Observational-Tx 411 patients To identify independent predictors of VTE in critically-ill trauma patients who cannot receive chemical prophylaxis in order to identify a subset of patients who may benefit from aggressive screening and/or prophylactic inferior IVCF (vena cava filter) placement. 411 trauma patients with a mean age of 48 (SD 22) years and 8 (SD 9) ICU days were included. 72% were male and the mean ISS was 22 (SD 13). 30 (7.3%) patients developed VTE: 28 (6.8%) with LEDVT and 2 (0.5%) with PE. Risk factors for VTE with a p<0.2 on univariate analysis included: PMH of DVT, injury severity score (ISS), extremity fractures (Fx), and a pelvis or LE extremity Fx repair. After logistic regression, only PMH of DVT (OR=22.6) and any extremity Fx (OR=2.4) remained as independent predictors. 2
21. Rajasekhar A, Crowther M. Inferior vena caval filter insertion prior to bariatric surgery: a systematic review of the literature. J Thromb Haemost. 2010;8(6):1266-1270. Review/Other-Tx N/A To evaluate the evidence supporting placement of IVCFs (inferior vena cava filters) in patients undergoing bariatric surgery. Descriptive analysis suggests that IVCFs reduced PE; however, the strength of this observation is tempered by the lack of use of effective forms of prophylaxis and the failure to account for complications of IVCF placement. 4
22. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-1151. Experimental-Tx 18,113 patients To test whether either dose of dabigatran was noninferior to warfarin, as evaluated with the use of Cox proportional-hazards modeling. Rates of the primary outcome were 1.69% per year in the warfarin group, as compared with 1.53% per year in the group that received 110 mg of dabigatran (relative risk with dabigatran, 0.91; 95% confidence interval [CI], 0.74 to 1.11; P<0.001 for noninferiority) and 1.11% per year in the group that received 150 mg of dabigatran (relative risk, 0.66; 95% CI, 0.53 to 0.82; P<0.001 for superiority). The rate of major bleeding was 3.36% per year in the warfarin group, as compared with 2.71% per year in the group receiving 110 mg of dabigatran (P = 0.003) and 3.11% per year in the group receiving 150 mg of dabigatran (P = 0.31). The rate of hemorrhagic stroke was 0.38% per year in the warfarin group, as compared with 0.12% per year with 110 mg of dabigatran (P<0.001) and 0.10% per year with 150 mg of dabigatran (P<0.001). The mortality rate was 4.13% per year in the warfarin group, as compared with 3.75% per year with 110 mg of dabigatran (P = 0.13) and 3.64% per year with 150 mg of dabigatran (P = 0.051). 1
23. Decousus H, Leizorovicz A, Parent F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. 1998;338(7):409-415. Experimental-Tx 200 patients To compare the installation of a permanent vena caval filter with no filter and fixed-dose subcutaneous low-molecularweight heparin with adjusted-dose intravenous unfractionated heparin. At day 12, two patients assigned to receive filters (1.1 percent), as compared with nine patients assigned to receive no filters (4.8 percent), had had symptomatic or asymptomatic pulmonary embolism (odds ratio, 0.22; 95 percent confidence interval, 0.05 to 0.90). At two years, 37 patients assigned to the filter group (20.8 percent), as compared with 21 patients assigned to the no-filter group (11.6 percent), had had recurrent deep-vein thrombosis (odds ratio, 1.87; 95 percent confidence interval, 1.10 to 3.20). There were no significant differences in mortality or the other outcomes. At day 12, three patients assigned to low-molecular-weight heparin (1.6 percent), as compared with eight patients assigned to unfractionated heparin (4.2 percent), had had symptomatic or asymptomatic pulmonary embolism (odds ratio, 0.38; 95 percent confidence interval, 0.10 to 1.38). 1
24. Bikdeli B, Chatterjee S, Desai NR, et al. Inferior Vena Cava Filters to Prevent Pulmonary Embolism: Systematic Review and Meta-Analysis. J Am Coll Cardiol 2017;70:1587-97. Meta-analysis 1,986 studies: 4,201 patients To conduct a systematic review and meta-analysis of the published reports on the efficacy and safety of IVC filters. The authors' search retrieved 1,986 studies, of which 11 met criteria for inclusion (6 RCTs and 5 prospective observational studies). Quality of evidence for RCTs was low to moderate. Overall, patients receiving IVC filters had lower risk for subsequent PE (OR: 0.50; 95% confidence interval [CI]: 0.33 to 0.75); increased risk for DVT (OR: 1.70; 95% CI: 1.17 to 2.48); nonsignificantly lower PE-related mortality (OR: 0.51; 95% CI: 0.25 to 1.05); and no change in all-cause mortality (OR: 0.91; 95% CI: 0.70 to 1.19). Limiting the results to RCTs showed similar results. Findings were substantively similar across a wide range of sensitivity analyses. Good
25. Isogai T, Yasunaga H, Matsui H, Tanaka H, Horiguchi H, Fushimi K. Effectiveness of inferior vena cava filters on mortality as an adjuvant to antithrombotic therapy. Am J Med. 2015;128(3):312 e323-331. Observational-Tx 13,125 patients To compare the in-hospital mortality between patients who received a filter and patients who did not, using propensity score and instrumental variable methods. Of 13,125 eligible patients, 3948 received a filter, and 9177 did not receive a filter. The propensity score-matched analysis showed that filter use was significantly associated with lower in-hospital mortality than non use (2.6% vs 4.7%, P < .001; risk ratio 0.55; 95% confidence interval [CI], 0.43-0.71; risk difference -2.1%; 95% CI, -3.0% to -1.2%; number needed to treat, 48; 95% CI, 34-82). We obtained similar results in the inverse probability of treatment-weighting analysis. The instrumental variable analysis confirmed that filter use was associated with a decreased risk of in-hospital mortality with adjustment for all measured variables (risk difference -2.5%, 95% CI, -4.6% to -0.4%). 3
26. Raphael IJ, McKenzie JC, Zmistowski B, Brown DB, Parvizi J, Austin MS. Pulmonary embolism after total joint arthroplasty: cost and effectiveness of four treatment modalities. J Arthroplasty. 2014;29(5):933-937. Observational-Tx 294 patients To evaluate 4 treatment protocols for clinical efficacy and cost. We reviewed over 27,000 total joint arthroplasty (TJA) patients. Among patients who received warfarin, inferior vena cava filters (IVCFs) were associated with fewer complications and lower overall hospital costs compared to the use of heparin for the treatment of PE after TJA. 3
27. Stein PD, Matta F, Keyes DC, Willyerd GL. Impact of vena cava filters on in-hospital case fatality rate from pulmonary embolism. Am J Med. 2012;125(5):478-484. Observational-Tx 297,700 stable patients; 1,712,800 unstable patients To determine categories of patients with pulmonary embolism in whom vena cava filters reduce in-hospital case fatality rate. In-hospital case fatality rate was marginally lower in stable patients who received a vena cava filter: 21,420 of 297,700 (7.2%) versus 135,240 of 1,712,800 (7.9%) (P<.0001). Filters did not improve in-hospital case fatality rate if deep venous thrombosis was diagnosed in stable patients. A few stable patients (1.4%) received thrombolytic therapy. Such patients who received a vena cava filter had a lower case fatality rate than those who did not: 550 of 8550 (6.4%) versus 2950 of 19,050 (15%) (P<.0001). Unstable patients who received thrombolytic therapy had a lower in-hospital case fatality rate with vena cava filters than those who did not: 505 of 6630 (7.6%) versus 2600 of 14,760 (18%) (P<.0001). Unstable patients who did not receive thrombolytic therapy also had a lower in-hospital case fatality rate with a vena cava filter: 4260 of 12,850 (33%) versus 19,560 of 38,000 (51%) (P<.0001). 3
28. Stein PD, Matta F. Vena cava filters in unstable elderly patients with acute pulmonary embolism. Am J Med. 2014;127(3):222-225. Observational-Tx 21,095 patients To determine if vena cava filters are associated with a reduced in-hospital all-cause case fatality rate in unstable adults with pulmonary embolism, irrespective of age. Among 21,095 unstable patients with pulmonary embolism who received thrombolytic therapy, in-hospital all-cause case fatality rate was lower in every age group who received a vena cava filter in addition to thrombolytic therapy (P = .0012 to <.0001). Patients aged >/= 81 years showed the greatest absolute reduction of case fatality rate with filters (19.3%). Among 50,210 unstable patients who did not receive thrombolytic therapy, case fatality rate also was lower in every age group who received a vena cava filter (all P <.0001). Patients aged >/= 81 years with vena cava filters showed the greatest absolute risk reduction of case fatality rate (27.7%). 3
29. Carlbom DJ, Davidson BL. Pulmonary embolism in the critically ill. Chest. 2007;132(1):313-324. Review/Other-Tx N/A To study pulmonary embolism in the critically ill with considerations beyond anticoagulant therapy. The grave prognosis of heparin-induced thrombocytopenia warrants close surveillance, with rapid switching to lepirudin, argatroban, or fondaparinux necessary if it is suspected. Retrievable vena cava filters can be lifesaving, and at least one type may be safely removed after residence of nearly 1 year. 4
30. Pacouret G, Alison D, Pottier JM, Bertrand P, Charbonnier B. Free-floating thrombus and embolic risk in patients with angiographically confirmed proximal deep venous thrombosis. A prospective study. Arch Intern Med. 1997;157(3):305-308. Review/Other-Tx 95 patients To analyze the free-floating thrombus (FFT), often considered to be a risk factor for pulmonary embolism (PE), despite adequate anticoagulation therapy, in patients with proximal deep venous thrombosis. Both groups were well-matched according to age, sex, risk factors, and delay from onset of symptoms to treatment. Positive and negative predictive values of color venous duplex scanning for the diagnosis of an FFT were 91% and 55%, respectively. On admission, PE prevalence was 64% in the FFT group (40 of 62 patients) and 50% in the occlusive thrombus group (14 of 28 patients) (P=.19). Two patients were excluded on follow-up analysis (range, days 9-11) for preventive vena cava filtering (due to major bleeding in 1 and cholecystectomy in the other); the recurrent rate of PE was 3.3% in the FFT group (2 of 61 patients) and 3.7% in the occlusive thrombus group (1 of 27 patients). No symptomatic recurrent PE occurred between day 10 (range, days 9-11) and 3 months. Four patients died of evolutive neoplasm after hospital discharge. 4
31. Hann CL, Streiff MB. The role of vena caval filters in the management of venous thromboembolism. Blood Rev. 2005;19(4):179-202. Review/Other-Tx N/A To discuss advances in technology, the dramatic increase in the use of IVC filters, and the limited data on their efficacy in many clinical circumstances. We discuss the currently available IVC filters, data on their efficacy and safety and our assessment of appropriate indications for their use. 4
32. Matsuo K, Carter CM, Ahn EH, et al. Inferior vena cava filter placement and risk of hematogenous distant metastasis in ovarian cancer. Am J Clin Oncol. 2013;36(4):362-367. Observational-Tx 274 patients To evaluate (i) the patterns of recurrence or progression of disease; and (ii) survival outcomes of ovarian cancer patients who underwent IVC filter placement. Overall, 38 (13.9%) patients underwent perioperative IVC filter insertion, of which 37 (97.4%) were permanently placed. The most common indication was newly diagnosed venous thromboembolism (VTE) (52.6%). Patients with IVC filter placement for VTE were more likely to develop subsequent deep vein thrombosis (25% vs. 7.2%, odds ratio, 4.31, 95% confidence interval, 1.40-13.3, P = 0.019), have hematogenous distant metastasis as the site of first recurrence or progression of disease (12-mo hematogenous distant metastasis ratio, 45.2% vs. 13.6%, hazard ratio, 5.10, 95% confidence interval, 2.35-11.1, P < 0.001, multivariate analysis), and show decreased survival outcomes (median progression-free survival, 5.7 vs. 15.3 mo, P < 0.001: and median overall survival, 22.1 vs. 47.2 mo, P = 0.002, both multivariate analysis) when compared with patients without IVC filter placement. 4
33. Stein PD, Matta F, Sabra MJ. Case fatality rate with vena cava filters in hospitalized stable patients with cancer and pulmonary embolism. Am J Med. 2013;126(9):819-824. Observational-Tx 318,115 patients To test the hypothesis that stable patients with pulmonary embolism who have cancer might be a subset of patients who would show a lower case fatality rate with vena cava filters than without filters. In-hospital all-cause case fatality rate was lower with vena cava filters in stable patients with pulmonary embolism and solid malignant tumors providing they were aged >30 years, but there was variability according to type of tumor and age of patient. On average, case fatality rate among those >30 years with filters was 7070 of 69,350 (10.2%) (95% confidence interval, 10.0-10.4) versus 36,875 of 247,125 (14.9%) (95% confidence interval, 14.8-15.1) without filters (P <.0001) (relative risk 0.68). Among stable patients with hematological malignancies, case fatality rate, except in the elderly, was higher among those with vena cava filters than those without filters. 2
34. Abtahian F, Hawkins BM, Ryan DP, et al. Inferior vena cava filter usage, complications, and retrieval rate in cancer patients. Am J Med. 2014;127(11):1111-1117. Review/Other-Tx 666 patients To perform a review of retrievable inferior vena cava filter use at a tertiary referral hospital between January 1, 2009 and December 31, 2011. Of 666 patients receiving retrievable inferior vena cava filters during this time period, 247 (37.1%) had active cancer. Of these, 151 (22.7%) had carcinoma, 92 (13.8%) had sarcoma, and 115 (17.3%) had metastatic disease. Overall, follow-up was available for a median of 401.0 (interquartile range: 107.5-786.5) days. Indwelling filter-related complications occurred in 19.8% of patients without cancer and 17.7% with an active cancer (P = .50). Patients with cancer were less likely to have the filter retrieved (28.0% vs 42.0%, P < .001). In multivariable analysis, cancer was not associated with filter-related complications but was associated with a lower rate of filter retrieval. 4
35. Barginear MF, Gralla RJ, Bradley TP, et al. Investigating the benefit of adding a vena cava filter to anticoagulation with fondaparinux sodium in patients with cancer and venous thromboembolism in a prospective randomized clinical trial. Support Care Cancer. 2012;20(11):2865-2872. Experimental-Tx 64 patients To evaluate the addition of a vena cava filter placement to anticoagulation with the factor Xa inhibitor fondaparinux sodium in patients with cancer. No patient had a recurrent deep vein thrombosis; two (3 %) patients had new pulmonary emboli, one in each randomized cohort. Major bleeding occurred in three patients (5 %). Two patients on the vena cava filter arm (7 %) had complications from the filter. Median survivals were 493 days in the anticoagulation only arm and 266 days for anticoagulation + vena cava filter (p < 0.57). Complete resolution of venous thromboembolism occurred in 51 % of patients within 8 weeks of initiating anticoagulation. 1
36. Segal JB, Streiff MB, Hofmann LV, Thornton K, Bass EB. Management of venous thromboembolism: a systematic review for a practice guideline. Ann Intern Med. 2007;146(3):211-222. Review/Other-Tx N/A To review the evidence on the efficacy of interventions for treatment of deep venous thrombosis (DVT) and pulmonary embolism. Moderately strong evidence supports early use of compression stockings to reduce postthrombotic syndrome. Limited evidence suggests that vena cava filters are only modestly efficacious for prevention of pulmonary embolism. Conventional-intensity oral anticoagulation beyond 12 months may be optimal for patients with unprovoked venous thromboembolism, although patients with transient risk factors benefit little from more than 3 months of therapy. High-quality trials support use of LMWH in place of oral anticoagulation, particularly in patients with cancer. Little evidence is available to guide treatment of venous thromboembolism during pregnancy. 4
37. Stein PD, Matta F. Vena cava filters in hospitalised patients with chronic obstructive pulmonary disease and pulmonary embolism. Thromb Haemost. 2013;109(5):897-900. Observational-Tx 440,370 patients To test our hypothesis that high case fatality rates of patients with chronic obstructive pulmonary disease (COPD) who have pulmonary embolism (PE) might benefit from vena cava filters, we assessed the database of the Nationwide Inpatient Sample. Case fatality rate was age-dependent. Only those who were older than aged 50 years had a lower in-hospital all-cause case fatality rate with filters. Among such patients, absolute risk reduction was 2.1% (95% CI = 1.9-2.3). The greatest reduction of case fatality rate with vena cava filters was shown in patients >aged 80 years, 11,720 of 81,600 (14.4%) compared with 1,570 of 17,220 (9.1%) (p<0.0001). 3
38. Krivak TC, Zorn KK. Venous thromboembolism in obstetrics and gynecology. Obstet Gynecol. 2007;109(3):761-777. Review/Other-Tx N/A To discuss the utilization of D-dimer testing and spiral or helical computed tomography scans, and low molecular weight heparin for the prevention and treatment of venous thromboembolism. Further studies are needed to determine optimal prevention and treatment strategies, particularly in the obstetric population. 4
39. Stone SE, Morris TA. Pulmonary embolism during and after pregnancy. Crit Care Med. 2005;33(10 Suppl):S294-300. Review/Other-Tx N/A To assert that evaluation alone is insufficient for the diagnosis of venous thromboembolic disease, and establish that the normal pregnant state makes this evaluation even more challenging. Venous thromboembolic disease is a significant cause of morbidity and mortality during pregnancy and the puerperal period. Objective testing is critical to establish the diagnosis and can be safely performed during pregnancy. Anticoagulation with heparin is the mainstay of therapy during the pregnancy, but patients may be transitioned to warfarin after delivery. 4
40. Timsit JF, Farkas JC, Boyer JM, et al. Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest. 1998;114(1):207-213. Observational-Tx 208 patients To evaluate the incidence and risk factors for catheter-related central vein thrombosis in ICU patients. Fifty-seven catheters were excluded from the analysis. Therefore 208 catheters were analyzed. Mean age of patients was 64+/-15 years, simplified acute physiologic score was 12+/-5, organ system failure score at insertion was 1+/-1, and mean duration of catheterization was 9+/-5 days. A catheter-related internal jugular or subclavian vein thrombosis occurred in 33% of the cases (42% [95% confidence interval (CI), 34 to 49%] and 10% [95% CI, 3 to 18%], respectively). Thrombosis was limited in 8%, large in 22%, and occlusive in 3% of the cases. Internal jugular route (relative risk [RR], 4.13; 95% CI, 1.72 to 9.95), therapeutic heparinization (RR 0.47; 95% CI, 0.23 to 0.99), and age >64 years (RR, 2.44; 95% CI, 2.05 to 3.19) were independently associated with catheter-related thrombosis. Moreover, the risk of catheter-related sepsis was 2.62-fold higher when thrombosis occurred (p=0.011). 2
41. Ray CE, Jr., Prochazka A. The need for anticoagulation following inferior vena cava filter placement: systematic review. Cardiovasc Intervent Radiol. 2008;31(2):316-324. Review/Other-Tx N/A To perform a systemic review to determine the effect of anticoagulation on the rates of venous thromboembolism (pulmonary embolus, deep venous thrombosis, inferior vena cava (IVC) filter thrombosis) following placement of an IVC filter. The summary odds ratio for the effect of anticoagulation on venous thromboembolism rates following filter deployment was 0.639 (95% CI 0.351 to 1.159, p = 0.141). There was significant heterogeneity in the results from different studies [Q statistic of 15.95 (p = 0.043)]. Following the meta-analysis, there was a trend toward decreased venous thromboembolism rates in patients with post-filter anticoagulation (12.3% vs. 15.8%), but the result failed to reach statistical significance. 4
42. Shaw CM, Scorza LB, Waybill PN, Singh H, Lynch FC. Optional vena cava filter use in the elderly population. J Vasc Interv Radiol. 2011;22(6):824-828. Observational-Tx 53 patients received an optional filter; 445 received a permanent filter To review utility, safety, and efficacy of optional inferior vena cava (IVC) filters in patients 65 years or older at a single institution over a 6-year period. Fifty-three patients received an optional filter and 445 received a permanent filter. Technical success rates for filter placement in the permanent and optional filter groups were 99.8% (447 of 448) and 98.1% (53 of 54), respectively (P = .51). Rates of PE after filter placement were 0% and 1.4% (five of 359) in the optional and permanent filter groups, respectively (P = .87). Incidences of deep vein thrombosis were 12% (six of 50) and 4.5% (16 of 359) in optional and permanent filter recipients, respectively (P = .06). Filter retrieval was attempted in 55.6% of optional filter recipients (30 of 54), similar to that seen in patients of any age with optional filters. Retrieval was unsuccessful in one patient in whom a suprarenal IVC filter was placed. 2
43. Muriel A, Jimenez D, Aujesky D, et al. Survival effects of inferior vena cava filter in patients with acute symptomatic venous thromboembolism and a significant bleeding risk. J Am Coll Cardiol. 2014;63(16):1675-1683. Experimental-Tx 40,142 eligible patients To investigate the survival effects of inferior vena cava filters in patients with venous thromboembolism (VTE) who had a significant bleeding risk. Of the 40,142 eligible patients who had acute symptomatic VTE, 371 underwent filter placement because of known significant bleeding risk. A total of 344 patients treated with a filter were matched with 344 patients treated without a filter. Propensity score-matched pairs showed a nonsignificant trend toward lower risk of all-cause death for filter insertion compared with no insertion (6.6% vs. 10.2%; p = 0.12). The risk-adjusted PE-related mortality rate was lower for filter insertion than no insertion (1.7% vs. 4.9%; p = 0.03). Risk-adjusted recurrent VTE rates were higher for filter insertion than for no insertion (6.1% vs. 0.6%; p < 0.001). 1
44. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study. Circulation. 2005;112(3):416-422. Experimental-Tx 400 patients To assess the very long-term effect of permanent vena cava filters that reduced the incidence of pulmonary embolism but increased that of deep-vein thrombosis at 2 years, in a randomized trial in patients with proximal deep-vein thrombosis. Four hundred patients with proximal deep-vein thrombosis with or without pulmonary embolism were randomized either to receive or not receive a filter in addition to standard anticoagulant treatment for at least 3 months. Data on vital status, venous thromboembolism, and postthrombotic syndrome were obtained once a year for up to 8 years. All documented events were reviewed blindly by an independent committee. Outcome data were available in 396 patients (99%). Symptomatic pulmonary embolism occurred in 9 patients in the filter group (cumulative rate 6.2%) and 24 patients (15.1%) in the no-filter group (P=0.008). Deep-vein thrombosis occurred in 57 patients (35.7%) in the filter group and 41 (27.5%) in the no-filter group (P=0.042). Postthrombotic syndrome was observed in 109 (70.3%) and 107 (69.7%) patients in the filter and no-filter groups, respectively. At 8 years, 201 (50.3%) patients had died (103 and 98 patients in the filter and no-filter groups, respectively). 1
45. Ren W, Li Z, Fu Z, Fu Q. Analysis of risk factors for recurrence of deep venous thrombosis in lower extremities. Med Sci Monit. 2014;20:199-204. Observational-Tx 218 patients To investigate the risk factors for recurrence of deep venous thrombosis (DVT) in the lower extremities. Univariate analysis showed the incidence of recurrent DVT in patients with concomitant malignancy was 3 times higher than that in patients without malignancy (P<0.01); the incidence of recurrent DVT in patients with inferior vena cava filter (IVCF) at initial treatment was increased by 4.3 times as compared to patients treated with other modalities. In addition, pathological types of DVT (P=0.047), diabetes (P=0.040), nephrotic syndrome (NS; P=0.040), systemic lupus erythematosus (SLE; P=0.031) and poor compliance after discharge (P=0.030) were closely related to increased incidence of recurrent DVT. However, age (t=-1.927, P=0.055), gender (P=0.664), primary hypertension (P=0.098), embolectomy (P=0.367), and anti-coagulation (P=0.338) at initial treatment were not associated with recurrence of DVT. Multivariate analysis revealed that the risk for recurrent DVT in patients with concomitant malignancy was 3.5 times higher than that in patients without malignancy (OR=3.494, P<0.05); the risk for recurrent DVT in patients with IVCF at initial treatment was increased by 4.6 times as compared to patients treated with other modalities (OR=4.658, P<0.05). Pathological types of DVT, concomitant diabetes, NS, SLE and poor compliance after discharge were not associated with the risk for recurrent DVT (P>0.05). 3
46. Smouse HB, Mendes R, Bosiers M, Van Ha TG, Crabtree T. The RETRIEVE trial: safety and effectiveness of the retrievable crux vena cava filter. J Vasc Interv Radiol. 2013;24(5):609-621. Experimental-Tx 125 patients To evaluate the safety and effectiveness of the Crux vena cava filter in patients at risk for pulmonary embolism (PE). The clinical success rate was 96.0% (120 of 125), with a one-sided lower limit of the 95% confidence interval of 91.8%. The rate of technical success was 98.4% (123 of 125). There were three cases of definite PE (2.4%), two cases of deployment failure, and no cases of device migration, embolization, fracture, or tilting. Investigators observed nine cases of thrombus (all nonocclusive) in or near the filter (six during retrieval evaluation vena cavography, two during computed tomography [CT] scans for PE symptoms, and one during CT for cancer management) and 13 cases of deep vein thrombosis. Device retrieval was attempted at a mean of 84.6 days+/-57.6 (range, 6-190 d) after implantation and was successful for 98.1% of patients (53 of 54). All deaths (n = 14) were determined to be unrelated to the filter or PE. 2
47. Athanasoulis CA, Kaufman JA, Halpern EF, Waltman AC, Geller SC, Fan CM. Inferior vena caval filters: review of a 26-year single-center clinical experience. Radiology. 2000;216(1):54-66. Review/Other-Tx 1,765 filters; 1,731 patients To review a 26-year single-center clinical experience with inferior vena caval filters. The prevalence of observed post-filter PE was 5.6%. It was fatal in 3.7% of patients. In most patients, fatal PE occurred soon after filter insertion (median, 4.0 days; 95% CI: 2.2, 5.8 days). Major complications occurred in 0.3% of procedures. The prevalence of observed post-filter caval thrombosis was 2.7%. The 30-day mortality rate was 17.0% overall, higher among patients with neoplasms (19.5%) as compared with those without neoplasms (14.3%; P =.004). Filter efficacy and associated morbidity were not different in 46 patients with suprarenal filters. The rate of filters placed for prophylaxis was 4.7% overall and increased to 16.4% in 1998. From 1980 to 1996, there was a fivefold increase in the number of caval filter implants. In recent years, more filters were implanted in younger patients. 4
48. Joels CS, Sing RF, Heniford BT. Complications of inferior vena cava filters. Am Surg. 2003;69(8):654-659. Review/Other-Tx N/A To consider Inferior vena cava (IVC) filters as a safe and effective means of preventing pulmonary embolus. Long-term complications occur in a minority of patients and include recurrent pulmonary embolus, caval occlusion, and filter migration. Overall, the benefits of preventing pulmonary embolism far exceed the risks related to filter placement in properly selected patients. 4
49. Stavropoulos SW. Inferior vena cava filters. Tech Vasc Interv Radiol. 2004;7(2):91-95. Review/Other-Tx N/A No results stated in abstract No results stated in abstract 4
50. Cina A, Masselli G, Di Stasi C, et al. Computed tomography imaging of vena cava filter complications: a pictorial review. Acta Radiol. 2006;47(2):135-144. Review/Other-Tx N/A To describe the normal CT aspect of cava filters, the classification of complications and their CT findings. Technical considerations for adequate CT imaging are highlighted. 4
51. Mismetti P, Laporte S, Pellerin O, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA. 2015;313(16):1627-1635. Experimental-Tx 200 patients To evaluate the efficacy and safety of retrievable vena cava filters plus anticoagulation vs anticoagulation alone for preventing pulmonary embolism recurrence in patients presenting with acute pulmonary embolism and a high risk of recurrence. In the filter group, the filter was successfully inserted in 193 patients and was retrieved as planned in 153 of the 164 patients in whom retrieval was attempted. By 3 months, recurrent pulmonary embolism had occurred in 6 patients (3.0%; all fatal) in the filter group and in 3 patients (1.5%; 2 fatal) in the control group (relative risk with filter, 2.00 [95% CI, 0.51-7.89]; P = .50). Results were similar at 6 months. No difference was observed between the 2 groups regarding the other outcomes. Filter thrombosis occurred in 3 patients. 1
52. Seshadri T, Tran H, Lau KK, Tan B, Gan TE. Ins and outs of inferior vena cava filters in patients with venous thromboembolism: the experience at Monash Medical Centre and review of the published reports. Intern Med J. 2008;38(1):38-43. Review/Other-Tx 83 patients with VT (Vena Tech) filter insertion: 42 patients with GT (Gunther Tulip) filter insertion To evaluate our institution's practice of permanent Vena Tech (B. Braun Medical S.A., Boulogne, France) and retrievable Gunther Tulip (William Cook Europe, Bjaeverskov) IVC filters and to review the available published reports. Eighty-three and 42 patients had a VT and GT filter inserted, respectively. Median age was 57 years for VT and 63 years for GT. The majority (75% for VT and 83% for GT) was inserted for acute VTE and contraindication to anticoagulation. Both filters were efficacious at preventing pulmonary embolism (PE) and there was a low rate of recurrent deep venous thrombosis in both groups. Insertion-related complications were low in both groups. Of the GT filters (n = 42), 16 were deemed an ongoing requirement, and thus, removal was not planned. In a further six patients, there was insufficient documentation as to why removal was not planned. Removal was attempted in 19 patients and was successful in 11. Failure of removal was as a result of clot in the filter (n = 7) or inability to snare it (n = 1). 4
53. Hoffer EK, Mueller RJ, Luciano MR, Lee NN, Michaels AT, Gemery JM. Safety and efficacy of the Gunther Tulip retrievable vena cava filter: midterm outcomes. Cardiovasc Intervent Radiol. 2013;36(4):998-1005. Review/Other-Tx 369 patients To evaluate of the medium-term integrity, efficacy, and complication rate associated with the Gunther Tulip vena cava filter. Mean clinical follow-up was 780 days. New or recurrent pulmonary embolus occurred in 12 patients (3.3%). New or recurrent deep-vein thrombosis occurred in 53 patients (14.4%). There were no symptomatic fractures, migrations, or caval perforations. Imaging follow-up in 287 patients (77.8%) at a mean of 731 days revealed a single (0.3%) asymptomatic fracture, migration greater than 2 cm in 36 patients (12.5%), and no case of embolization. Of 122 patients with CT scans, asymptomatic perforations were identified in 53 patients (43.4%) at a mean 757 days. 4
54. Ho KM, Tan JA, Burrell M, Rao S, Misur P. Venous thrombotic, thromboembolic, and mechanical complications after retrievable inferior vena cava filters for major trauma. Br J Anaesth. 2015;114(1):63-69. Observational-Tx 2940 patients; IVC filter retrievable in 23 patients To assess the risk factors for complications after using retrievable inferior vena cava (IVC) filters for primary or secondary thromboembolism prophylaxis in patients after major trauma. Of the 2940 major trauma patients admitted during the study period, a retrievable IVC filter was used in 223 patients (7.6%). Thirty-six patients (16%) developed DVT or VTE subsequent to placement of IVC filters (median 20 days, interquartile range 9-33), including 27 with lower limb (DVT), 8 upper limb DVT, and 4 pulmonary embolism. A high Injury Severity Score, tibial/fibular fractures, and a delay in initiating pharmacological thromboprophylaxis after insertion of the filters (14 vs 7 days, P=0.001) were significant risk factors. Thirty patients were lost to follow-up (13%) and their filters were not retrieved. Mechanical complications-including filters adherent to the wall of IVC (4.9%), IVC thrombus (4.0%), and displaced or tilted filters (2.2%)-were common when the filters were left in situ for >50 days. 3
55. Lorch H, Welger D, Wagner V, et al. Current practice of temporary vena cava filter insertion: a multicenter registry. J Vasc Interv Radiol. 2000;11(1):83-88. Review/Other-Tx 188 patients To evaluate the current practice of temporary vena cava filter placement and its complications. Deep vein thrombosis was proven in 95.2% of the patients. Main filter indication was thrombolysis therapy (53.1%). Average filter time was 5.4 days. An Antheor filter was inserted in 56.4%, a Guenther filter in 26.6%, and a Prolyser filter in 17.%. Transfemoral filter implantation was slightly preferred (54.8%). Four patients died of pulmonary embolism (PE) during filter protection. Major filter problems were filter thrombosis (16%) and filter dislocation (4.8%). When thrombus was found in or at the filter before explantation, additional thrombolysis was performed in 16.7%, additional filter implantation in 10%, and thrombus aspiration in 6.7%; 4.8% of filters were replaced with permanent filters. 4
56. Al-Hakim R, Kee ST, Olinger K, Lee EW, Moriarty JM, McWilliams JP. Inferior vena cava filter retrieval: effectiveness and complications of routine and advanced techniques. J Vasc Interv Radiol. 2014;25(6):933-939; quiz 940. Observational-Tx 217 patients To investigate the success and safety of routine versus advanced inferior vena cava (IVC) filter retrieval techniques. Filter retrieval was attempted 231 times in 217 patients (39% female, 61% male; mean age, 50.7 y), with success rates of 73.2% (169 of 231) and 94.7% (54 of 57) for routine and advanced filter retrieval techniques, respectively. The overall filter retrieval complication rate was 1.7% (four of 231); complications in four patients (with multiple complications in some cases) included IVC dissection, IVC intussusception, IVC thrombus/stenosis, filter fracture with embedded strut, IVC injury with hemorrhage, and vascular injury from complicated venous access. The rate of complications associated with filter retrievals that required advanced technique was significantly higher than seen with routine technique (5.3% vs 0.4%; P < .05). Longer dwell time, more transverse tilt, and presence of an embedded hook were associated with significantly increased rates of failed retrieval via routine technique (P < .05). 2
57. Nicholson W, Nicholson WJ, Tolerico P, et al. Prevalence of fracture and fragment embolization of Bard retrievable vena cava filters and clinical implications including cardiac perforation and tamponade. Arch Intern Med. 2010;170(20):1827-1831. Review/Other-Tx 80 patients To determine the prevalence of fracture and embolization of the Bard Recovery (first generation) and the Bard G2 (second generation) vena cava filters. Thirteen of 80 patients had at least 1 strut fracture (16%). At least 1 strut in 7 of the 28 Bard Recovery filters fractured and embolized (25%). In 5 of these 7 cases, patients had at least 1 fragment embolize to the heart (71%). Three patients experienced life-threatening symptoms of ventricular tachycardia and/or tamponade, including 1 patient who experienced sudden death at home. Six of 52 Bard G2 filters fractured (12%). In 2 of these 6 cases, the patients had asymptomatic end-organ fragment embolization. 4
58. U.S. Food & Drug Administration. Removing Retrievable Inferior Vena Cava Filters: FDA Safety Communication.  Available at: https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm. Review/Other-Tx N/A N/A N/A 4
59. Ghofrani HA, D'Armini AM, Grimminger F, et al. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med 2013;369:319-29. Experimental-Tx 261 patients To find more evidence to support riociguat, a member of a new class of compounds (soluble guanylate cyclase stimulators) that has been shown in previous clinical studies, to be beneficial in the treatment of chronic thromboembolic pulmonary hypertension. By week 16, the 6-minute walk distance had increased by a mean of 39 m in the riociguat group, as compared with a mean decrease of 6 m in the placebo group (least-squares mean difference, 46 m; 95% confidence interval [CI], 25 to 67; P<0.001). Pulmonary vascular resistance decreased by 226 dyn.sec.cm(-5) in the riociguat group and increased by 23 dyn.sec.cm(-5) in the placebo group (least-squares mean difference, -246 dyn.sec.cm(-5); 95% CI, -303 to -190; P<0.001). Riociguat was also associated with significant improvements in the NT-proBNP level (P<0.001) and WHO functional class (P=0.003). The most common serious adverse events were right ventricular failure (in 3% of patients in each group) and syncope (in 2% of the riociguat group and in 3% of the placebo group). 1
60. Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350(22):2257-2264. Review/Other-Tx 314 patients To assess the incidence of symptomatic CTPH (chronic thromboembolic pulmonary hypertension) in consecutive patients with an acute episode of pulmonary embolism but without prior venous thromboembolism. The cumulative incidence of symptomatic CTPH was 1.0 percent (95 percent confidence interval, 0.0 to 2.4) at six months, 3.1 percent (95 percent confidence interval, 0.7 to 5.5) at one year, and 3.8 percent (95 percent confidence interval, 1.1 to 6.5) at two years. No cases occurred after two years among the patients with more than two years of follow-up data. The following increased the risk of CTPH: a previous pulmonary embolism (odds ratio, 19.0), younger age (odds ratio, 1.79 per decade), a larger perfusion defect (odds ratio, 2.22 per decile decrement in perfusion), and idiopathic pulmonary embolism at presentation (odds ratio, 5.70). 4
61. Madani M, Mayer E, Fadel E, Jenkins DP. Pulmonary Endarterectomy. Patient Selection, Technical Challenges, and Outcomes. Ann Am Thorac Soc. 2016;13 Suppl 3:S240-247. Review/Other-Tx N/A To review patient selection, surgical technique, and outcomes for pulmonary endarterectomy in this patient population. No results stated in abstract. 4
62. Fedullo P, Kerr KM, Kim NH, Auger WR. Chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2011;183(12):1605-1613. Review/Other-Tx N/A To discuss advances in surgical techniques along with the introduction of pulmonary hypertension disease-modifying therapies that provide therapeutic options for the majority of patients afflicted with the disease. The current review focuses on the diagnostic approach to chronic thromboembolic pulmonary hypertension and the available surgical and medical therapeutic options. Additional research is necessary to more accurately predict postoperative hemodynamic outcome and to define the optimal therapeutic approach, especially in patients with involvement of the distal vasculature. 4
63. Jenkins D. New interventions to treat chronic thromboembolic pulmonary hypertension. Heart 2018. Review/Other-Tx N/A To discuss the three available treatment options that are dependent on the anatomical level of the obstruction: pulmonary endarterectomy surgery, balloon pulmonary angioplasty and pulmonary arterial hypertension (PAH)-targeted drugs for chronic thromboembolic pulmonary hypertension (CTEPH). No results stated in abstract. 4
64. Geerts WH, Jay RM, Code KI, et al. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med. 1996;335(10):701-707. Experimental-Tx 344 patients To compare low-dose heparin and a low-molecular-weight heparin with regard to efficacy and safety in a randomized clinical trial in patients with trauma. Among 344 randomized patients, 136 who received low-dose heparin and 129 who received enoxaparin had venograms adequate for analysis. Sixty patients given heparin (44 percent) and 40 patients given enoxaparin (31 percent) had deep-vein thrombosis (P=0.014). The rates of proximal-vein thrombosis were 15 percent and 6 percent, respectively (P=0.012). The reductions in risk with enoxaparin as compared with heparin were 30 percent (95 percent confidence interval, 4 to 50 percent) for all deep-vein thrombosis and 58 percent (95 percent confidence interval, 12 to 87 percent) for proximal-vein thrombosis. Only six patients (1.7 percent) had major bleeding (one in the heparin group and five in the enoxaparin group, P=0.12). 1
65. Somarouthu B, Yeddula K, Wicky S, Hirsch JA, Kalva SP. Long-term safety and effectiveness of inferior vena cava filters in patients with stroke. J Neurointerv Surg. 2011;3(2):141-146. Observational-Tx 371 patients To assess the long-term safety and clinical effectiveness of inferior vena cava (IVC) filters in patients with stroke. During this period, 371 patients (224 male; mean age 67.5 years) with stroke received an IVC filter. The stroke was hemorrhagic in 28%, ischemic in 20%, associated with intracranial malignancy in 21% and trauma in 31%. 235 (63%) patients (PE in 159) had venous thromboembolism on imaging. The indications for IVC filter included contraindication to anticoagulation in 251 (68%), prophylaxis in 83 (22%), added protection in 22 (6%) and complication or failure of anticoagulation in 15 (4%). There was one procedural complication. During a follow-up of 1.74+/-2.36 years, 180 (49%) patients died, three due to post-filter PE and the remainder all due to primary disease. Symptomatic post-filter PE and DVT occurred at a frequency of 15% (54/371) and 16% (60/371), respectively. Of these, 15 (4%) had imaging-proven PE. Three (0.8%) succumbed to post-filter PE. Imaging-proven new or recurrent DVT occurred in 6% and 8%, respectively. Symptomatic caval occlusion was seen in five (5/371, 1.3%). 3
66. Johns JS, Nguyen C, Sing RF. Vena cava filters in spinal cord injuries: evolving technology. J Spinal Cord Med. 2006;29(3):183-190. Review/Other-Tx N/A To clarify the use of vena cava filters in patients with SCI (spinal cord injury). Prophylactic use of vena cava filters has expanded in trauma patients, including individuals with SCI. Filter placement effectively prevents pulmonary emboli and has a low complication rate. Indications include pulmonary embolus while on anticoagulant therapy, presence of pulmonary embolus and contraindication for anticoagulation, and documented free-floating ileofemoral thrombus. VCFs should be considered in patients with complete motor paralysis caused by lesions in the high cervical cord (C2 and C3), with poor cardiopulmonary reserve, or with thrombus in the inferior vena cava despite anticoagulant prophylaxis. Three optional retrievable filters that are approved for use are discussed. 4
67. Sarani B, Chun A, Venbrux A. Role of optional (retrievable) IVC filters in surgical patients at risk for venous thromboembolic disease. J Am Coll Surg. 2005;201(6):957-964. Review/Other-Tx N/A To review risk factors for VTED in surgical patients, review efficacy and complications of IVC filters, and examine the role of new “optional” IVC filters in this patient population, based on a review of available medical literature. Of the current commercially available vena cava filters in the US, the Günther Tulip, OptEase, and Recovery filters allow for optional removal. Despite limited longterm data, these filters provide the surgeon with a therapeutic option in the management of patients at considerable risk for VTED who cannot receive anticoagulant therapy in the perioperative period. 4
68. Geerts WH. Prevention of venous thromboembolism in high-risk patients. Hematology Am Soc Hematol Educ Program. 2006:462-466. Review/Other-Tx N/A To perform a systematic literature review to summarize the risks and prevention of VTE in the following three groups: major trauma, spinal cord injury (SCI), or other critical illness. The use of prophylactic inferior vena caval filters is strongly discouraged because their potential benefit has not been shown to outweigh the risks or substantial costs. Implementation of thromboprophylaxis in these patients requires a local commitment to this important patient safety priority as well as a highly functional delivery system, based on the use of pre-printed orders, computer prompts, regular audit and feedback, and ongoing quality improvement efforts. 4
69. Girard TD, Philbrick JT, Fritz Angle J, Becker DM. Prophylactic vena cava filters for trauma patients: a systematic review of the literature. Thromb Res. 2003;112(5-6):261-267. Review/Other-Tx N/A To discover if there is evidence to support the safety and efficacy of prophylactic IVC filter placement in patients at high risk of PE after major trauma. Our review documents that there are short-term adverse outcomes of filter placement, and we remain concerned about the potential for long-term complications of filter placement in the relatively young population of trauma patients. 4
70. Hemmila MR, Osborne NH, Henke PK, et al. Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benefit for Trauma Patients. Ann Surg 2015;262:577-85. Observational-Tx 39,456 patients To examine the relationship between prophylactic inferior vena cava (IVC) filter use, mortality, venous thromboembolic (VTE) events. A prophylactic IVC filter was placed in 803 (2%) of 39,456 patients. Hospitals exhibited significant variability (0.6% to 9.6%) in adjusted rates of IVC filter utilization. Rates of IVC placement within quartiles were 0.7%, 1.3%, 2.1%, and 4.6%, respectively. IVC filter use quartiles showed no variation in mortality. Adjusting for pharmacological VTE prophylaxis and patient factors, prophylactic IVC filter placement was associated with an increased incidence of DVT (OR = 1.83; 95% CI, 1.15-2.93, P-value = 0.01). 2
71. Sarosiek S, Rybin D, Weinberg J, Burke PA, Kasotakis G, Sloan JM. Association Between Inferior Vena Cava Filter Insertion in Trauma Patients and In-Hospital and Overall Mortality. JAMA Surg 2017;152:75-81. Observational-Tx 1794 patients To determine if IVC filter insertion in trauma patients affects overall mortality. Among 451 trauma patients with an IVC filter and 1343 matched controls without an IVC filter, the mean (SD) age was 47.4 (21.5) years. The median Injury Severity Score overall was 24 (range, 1-75). Based on a mean follow-up of 3.8 years (range, 0-9.4 years), there was no significant difference in overall mortality or cause of mortality in patients with vs without an IVC filter who survived more than 24 hours from the time of injury, independent of the presence or absence of deep vein thrombosis or pulmonary embolism at the time of IVC filter placement. Additional analyses at shorter intervals of 6 months and 1 year after discharge also showed no significant difference between the 2 groups of patients. Eight percent (38 of 451) of the IVC filters were removed at Boston Medical Center during the follow-up period. 2
72. Rajasekhar A, Lottenberg L, Lottenberg R, et al. A pilot study on the randomization of inferior vena cava filter placement for venous thromboembolism prophylaxis in high-risk trauma patients. J Trauma. 2011;71(2):323-328; discussion 328-329. Experimental-Tx 38 patients To report the 2-year interim analysis of the filters in trauma pilot study. Thirty-four of 38 enrolled patients were eligible for analysis. The baseline sociodemographic characteristics were balanced between the both groups. Results of the feasibility objectives included: time from admission to enrollment (mean, 47.4 hours +/- 22.0 hours), time from enrollment to randomization (mean, 4.8 hours +/- 9.1 hours), time from randomization to IVCF placement (mean, 16.9 hours +/- 9.2 hours), adherence to weekly compression ultrasound within first month (IVCF group = 44.4%; non-IVCF group = 62.5%), and 1-month clinical follow-up (IVCF group = 83.3%; non-IVCF group = 100%). At 6-month follow-up, one PE in the nonfilter group and one DVT in the filter group had occurred. One non-PE-related death occurred in the filter group. Barriers to enrollment included inability to obtain informed consent due to patient refusal or no next of kin identified and delayed notification of eligibility status. 1
73. Haut ER, Garcia LJ, Shihab HM, et al. The effectiveness of prophylactic inferior vena cava filters in trauma patients: a systematic review and meta-analysis. JAMA Surg. 2014;149(2):194-202. Meta-analysis 8 studies: 4592 patients To perform a systematic review and meta-analysis examining the comparative effectiveness of prophylactic IVC filters in trauma patients, particularly in preventing PE, fatal PE, and mortality. Eight controlled studies compared the effectiveness of no IVC filter vs IVC filter on PE, fatal PE, deep vein thrombosis, and/or mortality in trauma patients. Evidence showed a consistent reduction of PE (relative risk, 0.20 [95% CI, 0.06-0.70]; I(2)=0%) and fatal PE (0.09 [0.01-0.81]; I(2)=0%) with IVC filter placement, without any statistical heterogeneity. We found no significant difference in the incidence of deep vein thrombosis (relative risk, 1.76 [95% CI, 0.50-6.19]; P=.38; I(2)=56.8%) or mortality (0.70 [0.40-1.23]; I(2)=6.7%). The number needed to treat to prevent 1 additional PE with IVC filters is estimated to range from 109 (95% CI, 93-190) to 962 (819-2565), depending on the baseline PE risk. Good
74. Still J, Friedman B, Furman S, et al. Experience with the insertion of vena caval filters in acutely burned patients. Am Surg. 2000;66(3):277-279. Review/Other-Tx N/A To discuss the usefulness of inferior vena caval filters in acutely burned patients at high risk of pulmonary emboli. In this small series, filter insertion appears to be effective and safe. 4
75. Brotman DJ, Shihab HM, Prakasa KR, et al. Pharmacologic and mechanical strategies for preventing venous thromboembolism after bariatric surgery: a systematic review and meta-analysis. JAMA Surg. 2013;148(7):675-686. Review/Other-Tx N/A To assess the comparative effectiveness and safety of pharmacologic and mechanical strategies to prevent venous thromboembolism (VTE) in patients undergoing bariatric surgery. Of 30,902 citations, we identified 8 studies of pharmacologic strategies and 5 studies of filter placement. No studies randomized patients to receive different interventions. One study suggested that low-molecular-weight heparin is more efficacious than unfractionated heparin in preventing VTE (0.25% vs 0.68%, P < .001), with no significant difference in bleeding. One study suggested that prolonged therapy (after discharge) with enoxaparin sodium may prevent VTE better than inpatient treatment only. There was insufficient evidence supporting the hypothesis that filters reduce the risk of pulmonary embolism, with a point estimate suggesting increased rates with filters (pooled relative risk [RR], 1.21 95% CI, 0.57-2.56). There was low-grade evidence that filters are associated with higher mortality (pooled RR, 4.30 95% CI, 1.60-11.54) and higher deep vein thrombosis rates (2.94 1.35-6.38). 4
76. Li W, Gorecki P, Semaan E, Briggs W, Tortolani AJ, D'Ayala M. Concurrent prophylactic placement of inferior vena cava filter in gastric bypass and adjustable banding operations in the Bariatric Outcomes Longitudinal Database. J Vasc Surg. 2012;55(6):1690-1695. Observational-Tx 322 CPIVCFs: 97,218 operations To establish associated characters and determine outcomes of concurrent prophylactic placement of an inferior vena cava filter (CPIVCF) for patients undergoing Roux-en-Y gastric bypass (GB) and adjustable gastric banding (AB) surgeries. A total of 322 CPIVCFs (0.33%) were identified from 97,218 GB and AB operations performed between 2007 and 2010 in this retrospective registry study. Significant differences were identified in male gender (21.1% vs 31.4%; P < .001), preoperative body mass index (BMI; 44.5 +/- 6.6 vs 45.3 +/- 7; P < .001), and African-American race (10.5% vs 18%; P < .001) between non-CPIVCF and CPIVCF groups. The CPIVCF group had more patients with previous nonbariatric surgery (50% vs 43.6%; P = .02), a history of venous thromboembolism (VTE; 21.4% vs 3.1%; P < .001), impairment of functional status (7.8% vs 3.1%; P < .001), lower extremity edema (47.2% vs 27.1%; P < .001), obesity hypoventilation syndrome (7.1% vs 2.1%; P < .001), obstructive sleep apnea syndrome (58.1% vs 43.3%; P < .001), and pulmonary hypertension (13% vs 4.1%; P < .001). Patients in the CPIVCF group were more likely to receive GB than gastric banding (77% vs 58.1%; P < .001) and an open surgical approach (21.4% vs 4.8%; P < .001). Operative duration was longer in the CPIVCF group (119 +/- 67 vs 89 +/- 52 minutes; P < .001). The CPIVCF group also had a longer length of hospital stay (3 +/- 2 vs 2 +/- 6 days; P = .048), was associated with higher incidence of deep venous thrombosis (DVT; 0.93% vs 0.12%; P < .001), and had a higher mortality (0.31% vs 0.03%; P = .003) from PE and indeterminate causes. In multivariate analysis, male gender, African-American race, previous nonbariatric surgery, a high BMI, obesity hypoventilation syndrome, history of VTE, lower extremity edema, and pulmonary hypertension were preoperative factors associated with CPIVCF. 3
77. Rowland SP, Dharmarajah B, Moore HM, et al. Inferior vena cava filters for prevention of venous thromboembolism in obese patients undergoing bariatric surgery: a systematic review. Ann Surg 2015;261:35-45. Review/Other-Tx 497 patients To review the evidence for the use of IVC filters in bariatric surgical patients, describe trends in practice, and discuss challenges in developing evidence-based guidelines. No results stated in abstract. 4
78. Ginzburg E, Cohn SM, Lopez J, Jackowski J, Brown M, Hameed SM. Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma. Br J Surg. 2003;90(11):1338-1344. Experimental-Tx 442 patients. To perform a prospective randomized trial to test the efficacy of intermittent pneumatic compression (IPC) devices in silent deep vein thrombosis patients. There were no significant differences in time spent in intensive care, or the proportion of patients with pelvic fractures, spinal cord or head injuries between the two groups. Six patients (2.7 per cent) developed a DVT in the IPC group and one (0.5 per cent) in the LMWH group (P = 0.122). Pulmonary embolism occurred in one patient in each group. There were 13 minor bleeding episodes (four in the IPC group and nine in the LMWH group) and eight major bleeding episodes (four in each group), none of which required operative intervention. 1
79. Dietch ZC, Edwards BL, Thames M, Shah PM, Williams MD, Sawyer RG. Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism. Surgery. 2015;158(2):379-385. Observational-Dx 442,108 patients To study our hypothesis that LUS screening for deep-vein thrombosis (DVT) is not associated with a reduced incidence of pulmonary embolism (PE). Overall, DVT and PE were reported in 0.94% and 0.37% of the study population, respectively. DVT and PE were reported more commonly in designated high-screening than low-screening facilities (DVT: 1.12% vs 0.72%, P < .0001; PE: 0.40% vs 0.33%, P = .0004). Multivariable logistic regression demonstrated that LUS was associated independently with DVT (odds ratio 1.43, confidence interval 1.34-1.53) but not PE (odds ratio 1.01, confidence interval 0.92-1.12) (c-statistic 0.86 and 0.85, respectively). Sensitivity analyses performed at various rates for designating HS facilities did not alter the significance of these relationships. 4
80. Sharifi M, Bay C, Skrocki L, Lawson D, Mazdeh S. Role of IVC filters in endovenous therapy for deep venous thrombosis: the FILTER-PEVI (filter implantation to lower thromboembolic risk in percutaneous endovenous intervention) trial. Cardiovascular &#38; Interventional Radiology. 35(6):1408-13, 2012 Dec. Experimental-Tx 141 patients To evaluate the necessity of and recommend indications for inferior vena cava (IVC) filter implantation during percutaneous endovenous intervention (PEVI) for deep venous thrombosis (DVT). PE developed in 1 of the 14 symptomatic patients in the filter group and 8 of the 22 patients in the control group (P = 0.048). There was no mortality in any group. Three patients (4.2%) in the control group had transient hemodynamic instability necessitating resuscitory efforts. Predictors of iatrogenic PE were found to be PE at admission; involvement of two or more adjacent venous segments with acute thrombus; inflammatory form of DVT (severe erythema, edema, pain, and induration); and vein diameter of >/=7 mm with preserved architecture. 1
81. Gyang E, Zayed M, Harris EJ, Lee JT, Dalman RL, Mell MW. Factors impacting follow-up care after placement of temporary inferior vena cava filters. J Vasc Surg. 2013;58(2):440-445. Observational-Tx 250 patients To determine demographic and clinical factors predictive of IVC filter follow-up care in a university hospital setting. In our cohort, 60.7% of patients received follow-up care; of those, 93% had IVC filter retrieval. Major indications for IVC filter placement were prophylaxis for high risk surgery (53%) and venous thromboembolic event with contraindication and/or failure of anticoagulation (39%). Follow-up care was less likely for patients discharged to acute rehabilitation or skilled nursing facilities (P < .0001), those with central nervous system pathology (eg, cerebral hemorrhage or spinal fracture; P < .0001), and for those who did not receive an IVC filter placement by a vascular surgeon (P < .0001). In a multivariate analysis, discharge home (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.99-8.2; P < .0001), central nervous system pathology (OR, 0.46; 95% CI, 0.22-0.95; P = .04), and IVC filter placement by the vascular surgery service (OR, 4.7; 95% CI, 2.3-9.6; P < .0001) remained independent predictors of follow-up care. Trauma status and distance of residence did not significantly impact likelihood of patient follow-up. 3
82. Johnson ON, 3rd, Gillespie DL, Aidinian G, White PW, Adams E, Fox CJ. The use of retrievable inferior vena cava filters in severely injured military trauma patients. J Vasc Surg. 2009;49(2):410-416; discussion 416. Review/Other-Tx N/A To further characterize R-IVCF outcomes in a trauma population with improved follow-up. Seventy-two R-IVCFs were placed during the study period. Mean follow-up was 28.0 +/- 12.0 months, in 61 (85%) patients. Mean injury severity score (ISS) was 36.3 +/- 10.4 and mean patient age was 27.4 +/- 6.4 years. Fifty-nine R-IVCFs (82%) were not retrieved due to: death (1, 1.3%), technical failure (2, 2.8%), lost to follow-up (11, 15.2%), or contraindications to retrieval (45, 62.5%). Thirteen R-IVCFs were successfully removed, an overall retrieval rate of 18%. Median dwell time of those removed was 47 days (range, 10-94). IVCF indications were prophylactic in 23 (32%) and therapeutic in 49 (68%) cases. Both retrieval failures were due to incorporation into the caval wall, attempted at 90 and 156 days. Deep vein thromboses at the insertion site or pulmonary embolism following R-IVCF placement or removal were not observed. To date, there have been no reports of IVC stenosis or occlusion. 4
83. Minocha J, Idakoji I, Riaz A, et al. Improving inferior vena cava filter retrieval rates: impact of a dedicated inferior vena cava filter clinic. J Vasc Interv Radiol. 2010;21(12):1847-1851. Review/Other-Tx N/A To test the hypothesis that an inferior vena cava (IVC) filter clinic increases the retrieval rate of optional IVC filters. In the preclinic and postclinic periods, 369 and 100 optional IVC filters were placed. Median (interquartile range) number of optional filters placed per month for preclinic and postclinic periods was 3 (range 2–5) and 10 (range 6.5–10.5) (P < .001). Retrieval rates in preclinic and postclinic periods were 108 of 369 (29%) and 60 of 100 (60%) (P < .001). The median time to filter retrieval in the postclinic group was 1.5 months (95% confidence interval 1.2–1.8). The number of failed retrieval attempts in preclinic and postclinic periods was 23 of 369 (6%) and 5 of 100 (5%) (P  .823). 4
84. Ko SH, Reynolds BR, Nicholas DH, et al. Institutional protocol improves retrievable inferior vena cava filter recovery rate. Surgery. 2009;146(4):809-814; discussion 814-806. Observational-Tx 94 patients To report the impact of an institutional protocol on retrieval rates of retrievable inferior vena cava filters (RIVCF) at a level I trauma center. Filter retrieval eligibility criteria were met in 81% (76/94) of patients in group I and in 61% (37/61) of patients in group II. Of those eligible, retrieval-attempt rates were 42% (32/76) in group I versus 95% (35/37) in group II (P < .001). Clinician oversight of the filter accounted for 89% (39/44) of failure of retrieval attempts; patient noncompliance accounted for the rest in group I. In group II, the latter accounted for all such failures. Retrieval was successful in 37% (28/76) and in 84% (31/37) of the eligible patients in groups I and II, respectively (P < .001). No retrieval procedure-related complications occurred. 3
85. Kalina M, Bartley M, Cipolle M, Tinkoff G, Stevenson S, Fulda G. Improved removal rates for retrievable inferior vena cava filters with the use of a 'filter registry'. Am Surg. 2012;78(1):94-97. Review/Other-Tx 307 patients To improve removal rates for r-IVCF. Three hundred seven patients received an IVCF, 142 preregistry and 165 postregistry. No significant difference existed between groups in age, gender, ISS, placement indication, or mortality. A significant difference existed between groups in LOS and presence of deep vein thrombosis (DVT) and pulmonary embolism. A total of 98.2 per cent of postregistry patients received a Gunther Tulip filter and all retrievals were performed by Interventional Radiology. Retrieval rates improved, 15.5 to 31.5 per cent post registry (P < 0.001). 4
86. Lynch FC. A method for following patients with retrievable inferior vena cava filters: results and lessons learned from the first 1,100 patients. J Vasc Interv Radiol. 2011;22(11):1507-1512. Review/Other-Tx 1,127 patients To review the efficacy of a method for patient follow-up was evaluated based on a retrospective review of a single-institutional retrievable IVC filter experience. Of 1,127 filters placed, 658 (58.4%) were removed. Filter removal or declaration of the device as permanent was achieved in 860 patients (76.3%). Filter removal, declaration of the device as permanent, or establishment of the need for continued follow-up was achieved in 941 patients (83.5%). Only 186 patients (16.5%) were lost to follow-up. 4
87. Hoppe H, Kaufman JA, Barton RE, et al. Safety of inferior vena cava filter retrieval in anticoagulated patients. Chest. 2007;132(1):31-36. Observational-Tx 110 patients To evaluate the safety of inferior vena cava (IVC) filter retrieval in therapeutically anticoagulated patients in comparison to prophylactically or not therapeutically anticoagulated patients with respect to retrieval-related hemorrhagic complications. Group 1 included 65 attempted filter retrievals in 61 therapeutically anticoagulated patients by measured INR or dosing when receiving low-molecular-weight heparin (LMWH). Four retrievals were not successful. In patients receiving oral anticoagulation, the median INR was 2.35 (range, 2 to 8). Group 2 comprised 23 successful filter retrievals in 22 patients receiving a prophylactic dose of LMWH. Group 3 included 27 attempted filter retrievals in 27 patients not receiving therapeutic anticoagulation. Six retrievals were not successful. Five patients were receiving oral anticoagulation with a subtherapeutic INR (median, 1.49; range, 1.16 to 1.69). No anticoagulation medication was administered in 22 patients. In none of the groups were hemorrhagic complications related to the retrieval procedures identified. 2
88. Kuo WT, Odegaard JI, Louie JD, et al. Photothermal ablation with the excimer laser sheath technique for embedded inferior vena cava filter removal: initial results from a prospective study. J Vasc Interv Radiol. 2011;22(6):813-823. Review/Other-Tx 25 patients To evaluate the safety and effectiveness of the excimer laser sheath technique for removing embedded inferior vena cava (IVC) filters. Laser-assisted retrieval was successful in 24 (96%) of 25 patients as follows: 11 Gunther Tulip (mean 375 days, range 127-882 days), 4 Celect (mean 387 days, range 332-440 days), 2 Option (mean 215 days, range 100-330 days), 4 OPTEASE (mean 387 days, range 71-749 days; 1 failed 188 days), 2 TRAPEASE (mean 871 days, range 187-1,555 days), and 2 Greenfield (mean 12.8 years, range 7.2-18.3 years). There was one (4%) major complication (acute thrombus, treated with thrombolysis), three (12%) minor complications (small extravasation, self-limited), and one adverse event (coagulopathic retroperitoneal hemorrhage) at follow-up (mean 126 days, range 13-302 days). Photothermal ablation of filter-adherent tissue was histologically confirmed in 23 (92%) of 25 patients. 4
89. Kuo WT, Cupp JS. The excimer laser sheath technique for embedded inferior vena cava filter removal. J Vasc Interv Radiol. 2010;21(12):1896-1899. Review/Other-Tx 1 patient To perform percutaneous filter retrieval using an excimer laser sheath technique for circumferential ablation of dense fibrotic tissue between the filter and IVC (inferior vena cava). N/A 4
90. Iliescu B, Haskal ZJ. Advanced techniques for removal of retrievable inferior vena cava filters. Cardiovasc Intervent Radiol. 2012;35(4):741-750. Review/Other-Tx N/A To describe the complex techniques for filter retrieval, including use of additional snares, guidewires, angioplasty balloons, and mechanical and thermal approaches as well as illustrates their specific application. No results stated in abstract 4
91. Rana MA, Gloviczki P, Kalra M, Bjarnason H, Huang Y, Fleming MD. Open surgical removal of retained and dislodged inferior vena cava filters. J Vasc Surg Venous Lymphat Disord 2015;3:201-6. Review/Other-Tx 6 patients To discuss the significant complications of retained inferior vena cava (IVC) filters. Struts of the filter perforated the IVC wall in all patients and the adjacent viscera in five. Caval clamping and longitudinal cavotomy with direct closure were used in two patients to remove permanent filters. IVC clamping was not needed in three patients, in whom the filter was first collapsed and then removed through a stab venotomy in the IVC (n = 2) or lumbar vein (n = 1). A broken strut that infected the vertebra was removed outside the IVC in the sixth patient. 4