10 Jul Retrievable Inferior Vena Cava Filters May Be Removed Despite Long Dwell Time
MedicalResearch.com Interview with:
Robert J. Lewandowski, MD FSIR
Associate Professor of Radiology
Director of Interventional Oncology
Department of Radiology
Northwestern University Feinberg School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Response: Retrievable inferior vena cava filters (rIVCF) were designed to provide temporary prevention from pulmonary embolism and then be removed when no longer needed. With permanent United States Food and Drug Administration (FDA) indication, these devices now account for the majority of IVC filters placed. Most rIVCFs placed are never removed because of poor clinical follow up, failed retrieval procedures, or patients not being offered the opportunity for filter removal secondary to prolonged dwell time; the latter has previously been correlated with retrieval failure.
Retrievable IVCFs appear to be subject to greater device related complications (e.g., filter penetration of the IVC, filter migration, filter fracture) relative to permanent devices; furthermore, the rates of these complications appear to increase with filter dwell time. This prompted the FDA to issue a 2010 safety alert urging removal of rIVCFs once they are deemed no longer necessary.
In the present study, we sought to determine whether rIVCF dwell time affects technical success of the retrieval procedure. Over a six-year period, 648 retrieval procedures were performed at our institution, with filter dwell times ranging from 0-108 months. We found that filter dwell time did not negatively impact IVC filter retrieval success nor did it increase our adverse events from the retrieval procedure. With advanced, adjunctive IVC filter retrieval techniques, rIVCFs can be safely and reliably removed despite long dwell times.
Medical Research: What should clinicians and patients take away from your report?
Response: Retrievable IVCFs can be safely removed with a high rate of technical success, regardless of filter dwell time. When weighed against the risks of leaving a device in place when no longer necessary, patients and their managing clinicians should seek consultation to have these devices removed. Since prolonged filter dwell time is associated with increased use of advanced filter retrieval techniques (including forceps and laser sheath-assisted photo-thermal fibrin ablation), clinicians should consider referral to a center with expertise in these advanced IVC filter removal procedures.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: It is important to recognize that there remains a paucity of prospective data in the utilization of IVC filters. The initiation of the PRESERVE trial, a multi-center prospective clinical research trial jointly organized between the Society of Interventional Radiology and the Society of Vascular Surgery, will add significant device-specific knowledge. The goal of this trial is to obtain a real-world view of the safety and effectiveness of most IVC filters placed in the United States.
Acknowledging the fact that not all medical centers have the expertise to perform advanced IVC filter retrievals, we believe that a next research step from our current work in optimizing the care of patients with IVC filters is to determine a more precise definition of prolonged dwell time. This information would help promote earlier IVC filter removal while also facilitating referral to centers with retrieval expertise for those patients with high likelihood of requiring advanced removal techniques.
Desai KR, Lewandowski RJ, Salem R, et al. Retrieval of Inferior Vena Cava Filters With Prolonged Dwell Time: A Single-Center Experience in 648 Retrieval Procedures. JAMA Intern Med. Published online June 22, 2015. doi:10.1001/jamainternmed.2015.2561.
Robert J. Lewandowski, MD FSIRAssociate Professor of Radiology (2015). Retrievable Inferior Vena Cava Filters May Be Removed Despite Long Dwell Time