Mid- and long-term outcome of patients with permanent inferior vena cava filters

Abstract

BACKGROUND: IVC filters are used to prevent pulmonary embolism (PE), especially in patients have active contraindication to anticoagulation. We aimed to investigate the outcomes of patients who received IVC filters in our institution. METHODS: Retrospective review of prospectively collected database on patients who had IVC filter was conducted. Patient demographics, indications of filter placement, post-procedure clinical outcome, as well as use of anticoagulant therapy were documented. Chi-square test was used to test for statistically significant differences, while survival was calculated using Kaplan-Meier survival curves analysis. RESULTS: Between February 1998 and December 2013, a total of 109 patients with a median age of 65 years had IVC filters inserted. All of them had documented venous thrombo-embolism (VTE) before filter placement: 90.8% had lower extremity DVT, 8.3% had massive PE without evidence of DVT and 0.9% had isolated IVC thrombosis. There were two serious procedure-related complications: one assess site thrombosis and one right ventricular perforation. With a mean follow-up of 36 ± 35 months, no patient had further symptomatic PE or paradoxical embolism. There were a total of 54 (49.5%) deaths, with a thirty-day mortality of 8.3%; none of them was device or procedure-related. Among the 92 patients followed up, twenty seven (29.3%) had further VTE – including 20 DVT and 14 filter/IVC thrombosis. Forty-one (44.6%) patients reported post-thrombotic syndrome (PTS) symptoms. Anticoagulant therapy was given to 39 (42.4%) and 55 (59.8%) patients in the peri-procedural period and at any time during the study period respectively. It did not reduce the rate of post-filter VTE or PTS in both instances. CONCLUSION: This cohort study showed that patients who received permanent IVC filters have high mortality on follow-up, although none were procedure- or device-related. Although IVC filters were effective in the prevention of PE, persistent symptomatic VTE was common..