Spanish multicenter real – life registry of retrievable vena cava filters (REFiVeC)

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Abstract

Background

The treatment of venous thromboembolic disease the treatment of choice is systemic anticoagulation. However, the interruption of the inferior vena cava with filters has been recommended when anticoagulation fails or there is a contraindication. Due to the rising inferior vena cava filter (IVCF) complications, physicians are encouraged to retrieve them when there is no longer recommended. In daily practice, it may be a difficult close follow-up of these patients. In this study, the primary objective was to evaluate the IVCF retrieval rate of all implanted filters in a Spanish registry. Secondary objectives were to analyze the causes of failed retrieval, procedure-related complications, and outcomes at a 12-month follow-up.

Results

Three hundred fifty-six vena cava filters were implanted in 355 patients. The types of filter were: Gunther Tulip (Cook Medical) 160 (44.9%), Optease (Cordis) 77 (21.6%), Celect (Cook Medical) 49 (13, 7%), Aegisy (Lifetech Scientific) 33 (9.2%), Option ELITE (Argon Medical devices) 16 (4.4%), Denali filter (BD Bard) 11 (3.08%), ALN filter (ALN) 10 (2.8%).

Removal was achieved in 274/356 (76,9%). eighty-two (23,1%) IVCF were not retrieved due to the following: 41 (11,5%) patients required ongoing filtration, 24 IVCF (6,7%) patients died before retrieval, and 17 (4,7%) impossibility of retrieval because of a tilted and embedded filter apex. There were no major complications observed.

Conclusions

The global retrieval rate of IVCF was achieved in 76.9%, and the adjusted retrieval rate was of 94.15% with no major complications. IVCF tilting was associated with failure of filter removal in less than 5% of cases. This study demonstrates that the retrieval procedure of IVCF is controlled by the clinician and not by the interventional radiologist.

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Most cited references 32

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Cirse Quality Assurance Document and Standards for Classification of Complications: The Cirse Classification System.

D Filippiadis, C. Binkert, O. Pellerin … (2017)

Interventional radiology provides a wide variety of vascular, nonvascular, musculoskeletal, and oncologic minimally invasive techniques aimed at therapy or palliation of a broad spectrum of pathologic conditions. Outcome data for these techniques are globally evaluated by hospitals, insurance companies, and government agencies targeting in a high-quality health care policy, including reimbursement strategies. To analyze effectively the outcome of a technique, accurate reporting of complications is necessary. Throughout the literature, numerous classification systems for complications grading and classification have been reported. Until now, there has been no method for uniform reporting of complications both in terms of definition and grading. The purpose of this CIRSE guideline is to provide a classification system of complications based on combining outcome and severity of sequelae. The ultimate challenge will be the adoption of this system by practitioners in different countries and health economies within the European Union and beyond.

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A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group.

Y Page, J Huet, Alain Leizorovicz … (1998)

The efficacy and safety of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis is still a matter of debate. Using a two-by-two factorial design, we randomly assigned 400 patients with proximal deep-vein thrombosis who were at risk for pulmonary embolism to receive a vena caval filter (200 patients) or no filter (200 patients), and to receive low-molecular-weight heparin (enoxaparin, 195 patients) or unfractionated heparin (205 patients). The rates of recurrent venous thromboembolism, death, and major bleeding were analyzed at day 12 and at two years. At day 12, two patients assigned to receive filters (1.1 percent), as compared with nine patients assigned to receive no filters (4.8 percent), had had symptomatic or asymptomatic pulmonary embolism (odds ratio, 0.22; 95 percent confidence interval, 0.05 to 0.90). At two years, 37 patients assigned to the filter group (20.8 percent), as compared with 21 patients assigned to the no-filter group (11.6 percent), had had recurrent deep-vein thrombosis (odds ratio, 1.87; 95 percent confidence interval, 1.10 to 3.20). There were no significant differences in mortality or the other outcomes. At day 12, three patients assigned to low-molecular-weight heparin (1.6 percent), as compared with eight patients assigned to unfractionated heparin (4.2 percent), had had symptomatic or asymptomatic pulmonary embolism (odds ratio, 0.38; 95 percent confidence interval, 0.10 to 1.38). In high-risk patients with proximal deep-vein thrombosis, the initial beneficial effect of vena caval filters for the prevention of pulmonary embolism was counterbalanced by an excess of recurrent deep-vein thrombosis, without any difference in mortality. Our data also confirmed that low-molecular-weight heparin was as effective and safe as unfractionated heparin for the prevention of pulmonary embolism.

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Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study.

(2005)

In a randomized trial in patients with proximal deep-vein thrombosis, permanent vena cava filters reduced the incidence of pulmonary embolism but increased that of deep-vein thrombosis at 2 years. An 8-year follow-up was performed to assess their very long-term effect. Four hundred patients with proximal deep-vein thrombosis with or without pulmonary embolism were randomized either to receive or not receive a filter in addition to standard anticoagulant treatment for at least 3 months. Data on vital status, venous thromboembolism, and postthrombotic syndrome were obtained once a year for up to 8 years. All documented events were reviewed blindly by an independent committee. Outcome data were available in 396 patients (99%). Symptomatic pulmonary embolism occurred in 9 patients in the filter group (cumulative rate 6.2%) and 24 patients (15.1%) in the no-filter group (P=0.008). Deep-vein thrombosis occurred in 57 patients (35.7%) in the filter group and 41 (27.5%) in the no-filter group (P=0.042). Postthrombotic syndrome was observed in 109 (70.3%) and 107 (69.7%) patients in the filter and no-filter groups, respectively. At 8 years, 201 (50.3%) patients had died (103 and 98 patients in the filter and no-filter groups, respectively). At 8 years, vena cava filters reduced the risk of pulmonary embolism but increased that of deep-vein thrombosis and had no effect on survival. Although their use may be beneficial in patients at high risk of pulmonary embolism, systematic use in the general population with venous thromboembolism is not recommended.

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Author and article information

Contributors

Miguel A. De Gregorio: mgregori@unizar.es

Jose A. Guirola: joseandresguirola@gmail.com

Jose Urbano: jurbano34@gmail.com

Ignacio Díaz-Lorenzo: drdiazlorenzo@gmail.com

Jose J. Muñoz: jjmrc1@gmail.com

Elena Villacastin: elenavillacastin@gmail.com

Antonio Lopez-Medina: lopez.medina.a@gmail.com

Ana L. Figueredo: anafigueredoc@gmail.com

Javier Guerrero: javierguerreromar@gmail.com

Sergio Sierre: sergio.sierre@usa.net

Javier Blazquez Sanchez: jblazquez@mdanderson.es

William T. Kuo: wkuo@stanford.edu

David Jimenez: djimenez.hrc@gmail.com

Journal

Journal ID (nlm-ta): CVIR Endovasc

Journal ID (iso-abbrev): CVIR Endovasc

Title: CVIR Endovascular

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2520-8934

Publication date (Electronic): 18 May 2020

Publication date PMC-release: 18 May 2020

Publication date Collection: December 2020

Volume: 3

Electronic Location Identifier: 26

Affiliations

[1 ]GRID grid.11205.37, ISNI 0000 0001 2152 8769, Hospital Universitario Lozano Blesa, , Universidad de Zaragoza, ; Zaragoza, Spain

[2 ]Hospitales Vithas, Madrid, Spain

[3 ]GRID grid.411251.2, ISNI 0000 0004 1767 647X, Hospital Universitario La Princesa, ; Madrid, Spain

[4 ]GRID grid.411457.2, Hospital Universitario Carlos Haya, ; Malaga, Spain

[5 ]GRID grid.411280.e, ISNI 0000 0001 1842 3755, Hospital Rio Hortega, ; Valladolid, Spain

[6 ]GRID grid.414269.c, ISNI 0000 0001 0667 6181, Hospital de Basurto Hospital, ; Bilbao, Spain

[7 ]GRID grid.411106.3, ISNI 0000 0000 9854 2756, Hospital Universitario Miguel Servet, ; Zaragoza, Spain

[8 ]Grupo Investigación Técnicas Mínimamente Invasivas (GITMI), Zaragoza, Spain

[9 ]GRID grid.411197.b, ISNI 0000 0004 0474 3725, Hospital Universitario Austral, ; Buenos Aires, Argentina

[10 ]GRID grid.411347.4, ISNI 0000 0000 9248 5770, Hospital Ramón y Cajal, ; Madrid, Spain

[11 ]GRID grid.240952.8, ISNI 0000000087342732, Department of Radiology, , Stanford University Medical Center, ; Stanford, CA USA

[12 ]GRID grid.411347.4, ISNI 0000 0000 9248 5770, Hospital Ramón y Cajal and Universidad de Alcalá (IRYCIS), ; Madrid, Spain

Article

Publisher ID: 114

DOI: 10.1186/s42155-020-00114-5

PMC ID: 7231811

PubMed ID: 32419040

SO-VID: 48209075-abc6-4093-953c-68398f2e8e60

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 5 January 2020

Date accepted : 17 March 2020

Custom metadata

Keywords: inferior vena cava filters,retrievable filters,venous thrombotic disease (vtd)

Data availability:

Keywords: inferior vena cava filters, retrievable filters, venous thrombotic disease (vtd)

Spanish multicenter real – life registry of retrievable vena cava filters (REFiVeC)

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Most cited references 32

Cirse Quality Assurance Document and Standards for Classification of Complications: The Cirse Classification System.

A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group.

Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study.

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