Inferior vena cava filters

The incidence of first-time venous thromboembolic (VTE) events is approximately 70–113 cases per 100,000 people per year. Approximately one-third of these cases are due to pulmonary embolism (PE). Venous thromboembolism will recur in approximately 7% of patients at 6 months, with patients presenting with PE more likely to have recurrent PE. Thirty-day mortality following PE is approximately 12%. While anti-coagulation remains the gold-standard therapy for VTE, patients who have recurrent PE despite adequate anticoagulation, high-risk patients with contraindications to anticoagulation, or patients who have bleeding complications while on anticoagulation therapy meet criteria for inferior vena cava (IVC) filter placement. Inferior vena cava filter placement is contraindicated in patients with complete thrombosis of the IVC, or with an IVC that is otherwise inaccessible by percutaneous means. Inferior vena cava filters are inserted percutaneously under local anesthesia via the femoral or jugular vein, with fluoroscopic or ultrasound guidance. The procedure usually takes less than 30 minutes, and consists of obtaining central venous access under ultrasound guidance. Venography is performed; fluoroscopic guidance may be used to measure the IVC, locate the renal veins, and identify any possible aberrant anatomy. Procedural morbidity is extremely rare and consists primarily of complications at the insertion site. Long-term complications are more significant and need to be considered when placing filters in young patients. Such complications include device migration, device fracture, caval thrombosis, IVC perforation, and post-thrombotic syndrome.