On August 9, 2010, the US Food and Drug Administration (FDA) issued a safety communication
warning that retrievable Inferior Vena Cava (IVC) filters, which are intended for
short-term placement are not always removed once the risk for pulmonary embolism or
the contraindication for anticoagulation subside [
]. The warning was based on the FDA's concerns about the increasing number of device
adverse reports involving IVC filters including device migration, embolization and
IVC perforation. The FDA encouraged all physicians caring for recipients of IVC filters
to consider risks and benefits of filter removal for each patient. However to date,
there are no clear or strict guidelines on the proper use and timely removal of IVC
filters. The incidence of IVC filter insertion has increased significantly over recent
years, especially since the availability of retrievable filters. It is estimated that
in 2007, almost 167,000 IVC filters were implanted in the United States compared to
only 2000 in 1979, and that in 2012, almost 259,000 filters would be deployed [
Is Market Growth of Vena Cava Filters Justified? A Review of indications, use and
]. This dramatic increase in the utilization of IVC filters was not accompanied by
efforts to ensure proper follow up and timely retrieval. To our knowledge, the only
long-term randomized controlled trial of IVC filters for the prevention of pulmonary
embolism was the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption
Cave) study [
- Decousus H.
- Leizorovicz A.
- Parent F.
- Page Y.
- Tardy B.
- Girard P.
- et al.
A clinical trial of vena cava filters in the prevention of pulmonary embolism in patients
with proximal deep vein thrombosis.
]. A total of 400 patients with proximal deep-vein thrombosis were followed initially
for two years. The insertion of an IVC filter in combination with standard anticoagulation
was associated with a reduction in the occurrence of pulmonary embolism compared with
anticoagulation alone. However, this beneficial effect was counterbalanced by a significant
increase in deep vein thrombosis and there was no survival advantage in the combination
group. In addition, the lower incidence of pulmonary embolism at 12 days post filter insertion was no longer apparent at 2 years. An 8 year follow up study showed the persistent increased risk of deep-vein thrombosis
and no survival advantage with the use of IVC filters [
Eight year follow up of patients with permanent vena cava filters in the prevention
of pulmonary embolism.
]. Given that the benefit of IVC filters appears to be short-term, the option of removing
the filter when it is no longer necessary is highly appealing. However, the actual
rate of filter removal remains low. In a retrospective study conducted by Gaspard
et. al, the rate of removal of retrievable IVC filters was only 3.7% [
- Gaspard S.F.
- Gaspard D.J.
Retrievable inferior vena cava filters are rarely removed.
]. Another study looking specifically at trauma patients found that only 20% of filters
were removed [
- Helling T.S.
- Kaswan S.
- Miller S.L.
- Tretter J.F.
Practice patterns in the use of retrievable inferior vena cava filters in a trauma
population: A single-Center Experience.
]. A recent retrospective study performed in a single institution in Australia found
that the rate of follow up after IVC filter placement was 39% and the rate of the
attempt at retrieval was 26.8% [
- Tan Xue Ling
- Tam Constantine
- Mckellar Ross
- Nandurkar Harshal
- Bazargan Ali
Audit of IVC filter retrieval.