Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minn.
J Vasc Surg Venous Lymphat Disord. 2022 Jul;10(4):887-893. doi: 10.1016/j.jvsv.2022.01.005. Epub 2022 Feb 3.
We investigated the clinical practice and volume trends of inferior vena cava filter (IVCF) usage at a single institution for an extended period and identified the potential factors affecting the clinical decision for placement, follow-up, and retrieval.
An institutional database was queried for IVCFs placed from 2000 to 2018 using the Current Procedural Terminology codes. The medical records were reviewed to evaluate the demographics, economic status, placement indication, IVCF type, follow-up evaluation for retrieval, and retrieval success rates. Statistical analysis was performed using SPSS, and t tests for continuous and χ for categorical variables.
A total of 3915 IVCFs were placed from 2000 to 2018. The placement of IVCFs had increased steadily from 2000 (127 IVCFs/y), peaking in 2010 at 371 IVCFs/y and representing a 292% increase in IVCF usage. Since 2010, the number of IVCFs placed has steadily declined until 2016 to 2018, with a 426% decrease from the peak. In a subgroup of IVCFs placed for prophylaxis, the total volume trends paralleled a shift in clinical indications, peaking in 2010 and accounting for 45% of all IVCFs placed and then decreasing from 2013 to 2018 to ≤10%. Overall, 989 permanent IVCFs (25.3%) and 2926 retrievable IVCFs (74.7%) were placed during the entire study period. Before dedicated efforts to implement retrieval follow-up visits, the successful retrieval rate was ∼1% from 2000 to 2006 and had increased to ∼10% to 15% from 2007 to 2015, 36.7% in 2016, 40.2% in 2017, and 40.3% in 2018 after implementation of more active retrieval follow-up protocols. The predictors for the lack of evaluation for IVCF retrieval included an extended length of stay (P = .004) and geographic distance (P < .001).
The use of IVCFs during the past 19 years at our institution reflected increased usage from 2000 to 2010, corresponding to an increase in prophylactic placement, followed by a decreasing total volume from 2011 to 2018, largely attributable to decreased prophylactic IVCF placement. Improved retrieval rates were seen after implementation of an active IVCF retrieval program.
我们在一家机构对下腔静脉滤器（IVCF）的临床实践和使用量趋势进行了长期研究，并确定了影响放置、随访和取出的临床决策的潜在因素。
使用当前操作术语代码，从 2000 年至 2018 年在机构数据库中查询 IVCF。审查病历以评估人口统计学、经济状况、放置指征、IVCF 类型、取出随访评估和取出成功率。使用 SPSS 进行统计分析，连续变量采用 t 检验，分类变量采用 χ 检验。
2000 年至 2018 年共放置 3915 个 IVCF。从 2000 年开始（127 个/年），IVCF 的放置量稳步增加，2010 年达到 371 个/年，使用率增加了 292%。自 2010 年以来，IVCF 的放置数量稳步下降，直到 2016 年至 2018 年，与峰值相比下降了 426%。在为预防而放置的 IVCF 亚组中，总容量趋势与临床指征的变化相一致，2010 年达到峰值，占所有 IVCF 放置量的 45%，然后从 2013 年至 2018 年下降至≤10%。总体而言，在整个研究期间，共放置 989 个永久性 IVCF（25.3%）和 2926 个可回收 IVCF（74.7%）。在专门努力实施取回随访之前，2000 年至 2006 年的成功取回率约为 1%，2007 年至 2015 年增加至约 10%至 15%，2016 年为 36.7%，2017 年为 40.2%，2018 年实施更积极的取回随访方案后为 40.3%。IVCF 取出评估缺失的预测因素包括住院时间延长（P=0.004）和地理距离（P<0.001）。
在过去的 19 年中，我们机构 IVCF 的使用情况反映了从 2000 年到 2010 年的使用率增加，这与预防性放置的增加相对应，随后从 2011 年到 2018 年总数量减少，主要归因于预防性 IVCF 放置减少。在实施积极的 IVCF 取出方案后，取出率有所提高。
