PB0459 - Retrieval rate and complications of inferior vena cava filters placed during acute venous thromboembolism.

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Davide Santagata, MD

Resident
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Como, Lombardia, Italy

Co-Author(s)

Walter Ageno, MD

Professor of Medicine
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Varese, Lombardia, Italy
MV

Massimo Venturini

Director, Associate Professor, MD
Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Varese, Lombardia, Italy
MD

Marco Paolo Donadini, MD, PhD

Professor of Internal Medicine
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Varese, Lombardia, Italy
FF

Federico Fontana

Assistant Professor, MD
Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Varese, Lombardia, Italy
FP

Filippo Piacentino

Staff Physician, MD
Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Varese, Lombardia, Italy

Background: Over the last two decades, inferior vena cava filters (IVFC) placement has increased, especially with the advent of retrievable IVCF. Despite an increase of IVCF retrieval after Food and Drug Administration warnings, retrieval rates remain poor. In addition, current indications for filter removal do not include a formal evaluation of patients’ comorbidities.

Aims: To evaluate the retrieval rate of IVCF and its determinants and to describe the long-term clinical course of patients with IVCF placement, including VTE (Venous Thromboembolism) events and filter complications.

Methods: A single-center retrospective cohort study was performed enrolling all patients diagnosed with acute deep vein thrombosis (DVTs) and/or pulmonary embolism (PE), who underwent IVCF placement from 2015 to 2019. The primary outcome was retrieval rates at 3, 6 and 12 months.

Results: 139 patients underwent IVCF placement due to temporary contraindications to full dose anticoagulation for acute VTE, 31 of whom remained without any anticoagulation even at discharge. We found a removal rate of 2,1%, 13,5% and 29,2% at 3, 9 and 12 months, respectively. Active cancer was significantly associated with the decision to not remove IVCF (OR 0,16; CI 95% 0,05 to 0,52), whereas surgical procedures up to 1 month before VTE event were significantly associated with filter removal (OR 3,43; CI 95% 1,19 to 9,88). During follow-up, 11 patients (7,9%) had lower limb DVT (4 during anticoagulation) and 7 patients (5,0%) were diagnosed with device-related complications (3 IVCF-tilting, 2 IVCF-occlusions and 1 caval-penetration). Overall, the mortality rate at 1 year was 42,6%.

Conclusion(s): Despite the 2014 FDA warning, the retrieval rate of IVCF is low. However, the results may be in part explained by the high mortality rate, that reflects a highly comorbid population. Indeed, active cancer was associated with the choice to not remove filters, whereas transient factors such as surgery were associated with filter retrieval.