[Vena cava filter. Indications, complications, clinical evaluation].

INTRODUCTION

Pulmonary embolism is the third leading cause of death in the western countries. If anticoagulation fails or is contra-indicated, or if the risk for pulmonary embolism is increased for other reasons, the percutaneous implantation of a vena cava filter should be considered.

METHODS

The available filters can be differentiated by the design (cone, basket, net-types), by the material, and by their removability. The rate of complications (caval thrombosis, fracture of filter) and the in vitro efficacy in trapping thrombotic clots is dependent on the specific filter type.

RESULTS

In clinical practice there is no evidence for significant differences in trapping efficacy among the different filters. About 4% of all patients treated by caval filters still can have pulmonary embolism, and 1% will have a fatal outcome. Dependent on the filter type, the most common complication is caval thrombosis, in up to 25% of cases.

CONCLUSION

The percutaneous implantation of caval filters can readily be performed by interventional radiologists. However, randomized clinical studies failed to clearly document efficacy of caval filters. Therefore, indication has to be considered carefully.