Sebunya Jonathan, Baschera Dominik, Isenegger Patrick, Zellweger Rene
Department of General Surgery, Royal Perth Hospital, Perth, Australia.
ANZ J Surg. 2011 Nov;81(11):804-9. doi: 10.1111/j.1445-2197.2010.05636.x.
The optional filter is gaining ground, supplementing anticoagulation in the management of venous thromboembolism (VTE) in high-risk surgical patients, this despite knowledge gaps relating to its efficacy. We studied the literature and audited our experience with inferior vena cava filters to educate ourselves on this mode of VTE prophylaxis, particularly its practical implications, if any, for the surgeon.
A retrospective clinical study on inferior vena cava filter (IVCF)-related events in a Western Australian tertiary centre in 2008 was performed. Literature on IVCFs was reviewed.
The 118 IVCF-related events at our centre in 2008, involved either Recovery-G2 75(88%) or Cook-Celect nine (11%). Of these, 78 were insertions and 36 were retrievals with four failed retrievals (10% of the attempts). Major indications for insertion included multi-trauma 32 (38%), prothrombotic state 29 (34%), head injury/intracranial bleeding 16 (19%) and others eight (9%). The mean dwelling time was 100 days (12–349 days). The mean age was 43 and the retrieval rate was 58%.
Optional filters have presented both versatility and challenge to the management of VTE in high-risk patients. An underlying concern about the quintessential efficacy of IVCFs lingers on, while the impact of lost follow-ups in young patients is still at large. Class 1 studies on optional filters would add certainty to the use of this generation of filters, be a step forward in relevance from the seminal work of Decousus and garner the willingness needed to engage teamwork and institutional proactiveness against loopholes such as lost follow-ups that can undermine the portrayed benefits of a potentially lifesaving device.
