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Circulation. 2015 Sep 8;132(10):944-52. doi: 10.1161/CIRCULATIONAHA.115.016468. Epub 2015 Jul 13.

Caval Penetration by Inferior Vena Cava Filters: A Systematic Literature Review of Clinical Significance and Management.

Author information

1
From Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.).
2
From Department of Interventional Radiology, No. 2 People's Hospital of Changzhou, Nanjing Medical University, Chang Zhou, China (Z.J.); Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, OH (A.W.); Department of Radiology, Southend University Hospital, Essex, UK (M.T.); Department of Radiology, Wexner Medical Center at The Ohio State University, Columbus (J.S.); and Department of Radiology, Mayo Clinic, Jacksonville, FL (J.M.M., W.W.). Wang.Weiping@mayo.edu.

Abstract

BACKGROUND:

Limited penetration into the caval wall is an important securing mechanism for inferior vena cava (IVC) filters; however, caval penetration can also cause unintentional complications. The aim of this study was to assess the incidence, severity, clinical consequences, and management of filter penetration across a range of commercially available IVC filters.

METHODS AND RESULTS:

The MEDLINE database was searched for all studies (1970-2014) related to IVC filters. A total of 88 clinical studies and 112 case reports qualified for analysis; these studies included 9002 patients and 15 types of IVC filters. Overall, penetration was reported in 19% of patients (1699 of 9002), and 19% of those penetrations (322 of 1699) showed evidence of organ/structure involvement. Among patients with penetration, 8% were symptomatic, 45% were asymptomatic, and 47% had unknown symptomatology. The most frequently reported symptom was pain (77%, 108 of 140). Major complications were reported in 83 patients (5%). These complications required interventions including surgical removal of the IVC filter (n=63), endovascular stent placement or embolization (n=11), endovascular retrieval of the permanent filter (n=4), and percutaneous nephrostomy or ureteral stent placement (n=3). Complications led to death in 2 patients. A total of 87% of patients (127 of 146) underwent premature filter retrieval or interventions for underlying symptoms or penetration-related complications.

CONCLUSIONS:

Caval penetration is a frequent but clinically underrecognized complication of IVC filter placement. Symptomatic patients accounted for nearly 1/10th of all penetrations; most of these cases had organ/structure involvement. Interventions with endovascular retrieval and surgery were required in most of these symptomatic patients.

KEYWORDS:

complications; embolic protection devices; vena cava filters; vena cava, inferior

[Indexed for MEDLINE]

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