Abstract
Many studies have supported the efficacy of inferior vena cava filters (IVCF) in the
setting of venous thromboembolic disease, particularly in oncologic patients who are
at increased risk. The advent of retrievable IVCF designs has prompted dramatically
expanded use for patients with widely accepted indications but also disproportionately
so in patients with so-called extended indications. At the same time, an alarming
increase in filter-related complications has been reported both in the literature
and through regulatory agencies, leading to government agency-issued warnings. The
synergistic effect of these two interconnected phenomena is explained through a careful
review of the evolution of IVCF device design. Critical differences exist when comparing
retrievable IVCF and permanent IVCF. IVCF utilization can be optimized by prospectively
identifying which patients are best served by a specific IVCF device. Careful follow-up
strategies are also needed to ensure that all IVCFs are removed as soon as they are
no longer needed. Finally, adjunctive techniques for removing “difficult” filters
help maximize the number of IVCF removed and minimize IVCF left implanted needlessly.
Keywords
inferior vena cava filters - pulmonary embolism - deep venous thrombosis - cancer
- complications
