Authors: Takuji Yamagami Osamu Tanaka Rika Yoshimatsu Hiroshi Miura Tsunehiko Nishimura
Publish Date: 2009/09/19
Volume: 33, Issue: 1, Pages: 74-79
Abstract
The purpose of this study was to examine the incidence of new or recurrent venous thromboembolism VTE after retrieval of inferior vena cava IVC filters and risk factors associated with such recurrence Between March 2001 and September 2008 at our institution implanted retrievable vena cava filters were retrieved in 76 patients The incidence of new or recurrent VTE after retrieval was reviewed and numerous variables were analyzed to assess risk factors for redevelopment of VTE after filter retrieval In 5 66 of the 76 patients redevelopment or worsening of VTE was seen after retrieval of the filter Three patients 40 had recurrent deep venous thrombosis DVT in the lower extremities and 2 26 had development of pulmonary embolism resulting in death Although there was no significant difference in the incidence of new or recurrent VTE related to any risk factor investigated a tendency for development of VTE after filter retrieval was higher in patients in whom DVT in the lower extremities had been so severe during filter implantation that interventional radiological therapies in addition to traditional anticoagulation therapies were required 40 in patients with recurrent VTE vs 23 in those without VTE p = 05866 according to Fisher’s exact probability test and in patients in whom DVT remained at the time of filter retrieval 60 in patients with recurrent VTE vs 37 in those without VTE p = 03637 In conclusion new or recurrent VTE was rare after retrieval of IVC filters but was most likely to occur in patients who had severe DVT during filter implantation and/or in patients with a DVT that remained at the time of filter retrieval We must point out that the fatality rate from PE after filter removal was high 26Although inferior vena cava IVC filter placement is known to be effective in reducing the risk of pulmonary embolism PE in selected patients 1 2 when only shortterm protection is required ideally a permanent IVC filter would not be placed considering the long life expectancy of such patients 2 3 Thus the use of a temporary vena cava filter has found widespread acceptance 4 5 However problems have been reported mainly related to the structure of these devices in that part of the device projects from the insertion site 5 6 7On the contrary no such problems have arisen in the use of commercially available retrievable filters which are permanent vena cava filters that can be retrieved when appropriate Paralleling the increased usage of retrievable vena cava filters in daily clinical practice reports of their use have increased 8 9 10 11 12 13 14 However most published reports have focused on the feasibility and safety of withdrawal of the filter 8 9 10 11 12 13 14 15 On the other hand there have been few large studies on venous thromboembolism VTE after removal of the filter 16 The purpose of the present study was to evaluate the incidence of VTE VTE defined as deep venous thrombosis DVT and/or PE after filter retrievalBetween February 2001 and July 2008 at our institution a Gunther Tulip retrievable vena cava filter GTF Cook Bjaeverskov Denmark which is among the commercially available retrievable vena cava filters was implanted in 163 patients Removal of the GTF was attempted after temporal implantation in 81 of these 163 patients with successful retrieval in 76 of the 81 patients 46 women 30 men mean age 593 years range 18–87 years These 76 patients comprise the cohort of the present study In this retrospective study data for analysis were obtained through review of each patient’s chart and results of analysis are described according to reporting standards recommended in previous reports 17 18
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