Primary prophylaxis of pulmonary embolus with retrievable IVC filter

Announced in the news today was the case of Doreen Carter who had an inferior vena cava filter inserted as an alternative for prophylaxis against thromboembolism.

http://www.bbc.co.uk/news/uk-england-berkshire-21655038

She was due to have bowel surgery and, presumably, was deemed too high risk for anticoagulation. The titanium device was also designed to be easily removed.

“Dr Carl Waldmann, a consultant at the hospital, said giving post-operative patients anti-clotting drugs can be risky, and existing measures to catch clots also carry risks because they are difficult to insert and remove.”

As the IVC filter devices and deployment skills have improved, especially of retrievable devices [1], there has been debate over when they should be used. [2]

 

1. Johnson MS, Nemcek AA Jr, Benenati JF, Baumann DS, Dolmatch BL, Kaufman JA, Garcia MJ, Stecker MS, Venbrux AC, Haskal ZJ, Avelar RL. The safety and effectiveness of the retrievable option inferior vena cava filter: a United States prospective multicenter clinical study. J Vasc Interv Radiol 2010 Aug;21(8):1173–1184.Available from: http://www.ncbi.nlm.nih.gov/pubmed/20598570

2. Wehrenberg-Klee E, Stavropoulos SW. Inferior vena cava filters for primary prophylaxis: when are they indicated? Semin Intervent Radiol 2012 Mar;29(1):29–35.Available from: http://www.ncbi.nlm.nih.gov/pubmed/23450194