[Vena cava filter. Which indications remain in the era of differentiated anticoagulation?].

CLINICAL/METHODICAL ISSUE: Venous thromboembolism (VTE) is the third most common disease of the cardiovascular system. It is associated with a 30-day lethality in the range of 6  % in deep vein thrombosis and 12  % in pulmonary embolism (PE). There are various guidelines with sometimes controversial recommendations regarding the use of inferior vena cava (IVC) filters.

STANDARD RADIOLOGICAL METHODS

Implantation of IVC filters is a standard therapy in selected patients with an estimated 259,000 filters implanted in 2012.

METHODICAL INNOVATIONS

Optionally retrievable filters are increasingly being used in clinical routine practice. Future developments will include biodegradable and drug-eluting filters.

PERFORMANCE

When compared to anticoagulation as the reference therapy of VTE, IVC filters will significantly reduce the frequency of symptomatic PE; however, there is no advantage in overall survival for either therapy.

ACHIEVEMENTS

Despite different guidelines in clinical routine practice the use of IVC filters appears to depend on the individual clinical experience and assessment of the interventionalist.

PRACTICAL RECOMMENDATIONS

Nowadays retrievable filters should be used although there are relevant differences between the various devices. As a matter of principle all IVC filters should be removed as soon as adequate anticoagulation can be established.