II. Indications: Prevent embolism in Deep Vein Thrombosis
-
Anticoagulation contraindicated (Fall Risk, Bleeding risk)
- High risk Hypercoagulable patients or
- High risk of Pulmonary Embolism (e.g. proximal DVT)
- Prolonged bed-bound status (e.g Trauma, paralysis, Severe Head Injury, Hip Fracture, Pelvic Fracture, Bariatric Surgery)
- Complication secondary to Anticoagulation
- Failed Anticoagulation
- Deep Vein Thrombosis extension
- Pulmonary Embolism despite Anticoagulation with therapeutic levels
- Hemorrhage
- Thrombocytopenia
- Warfarin skin necrosis
- Noncompliance with Anticoagulation protocol
- Failed Anticoagulation
III. Efficacy
- Lower Incidence of Pulmonary Embolism
- Does not reduce overall mortality
- Decousus (1998) N Engl J Med 12:338(7):409-15 [PubMed]
- Young (2010) Cochrane Database Syst Rev, CD006212
IV. Complications
- Overall complication rate: 1-2%
- Early complications
- Malpositioned IVC Filter (e.g. tilted)
- Insertion site Hematoma
- Deployment complication (e.g. filter fails to open completely)
- Late complications
- IVC Filter migration (e.g. into right atrium or superior vena cava)
- IVC Filter tilted or otherwise malpositioned
- IVC thrombosis
- IVC perforation (e.g. due to IVC Filter leg or strut fracturing)
- References
V. Precautions
- IVC Filters should only be used as bridging devices and then removed
- Risk of Pulmonary Embolism wanes
- Anticoagulation is no longer contraindicated
- FDA recommends removal of IVC Filter when no longer indicated
- However removal is difficult and fails in up to 8% of cases
- Lee (2015) Cardiovasc Intervent Radiol 38(6): 1502-7 [PubMed]
VI. References
- Shoenberger and Bright in Majoewsky (2013) EM:Rap 13(6): 8
- Girard (2002) Chest 122:963-7 [PubMed]
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| Definition (SPN) | A cardiovascular intravascular filter is an implant that is placed in the inferior vena cava for the purpose of preventing pulmonary thromboemboli (blood clots generated in the lower limbs and broken loose into the blood stream) from flowing into the right side of the heart and the pulmonary circulation. |
| Definition (MSH) | Mechanical devices inserted in the inferior vena cava that prevent the migration of blood clots from deep venous thrombosis of the leg. |
| Concepts | Medical Device (T074) |
| MSH | D016306 |
| SnomedCT | 257409000 |
| English | Cava Filter, Vena, Cava Filters, Vena, Filter, Inferior Vena Cava, Filter, Vena Cava, Filters, Inferior Vena Cava, Inferior Vena Cava Filter, Inferior Vena Cava Filters, Vena Cava Filter, FILTER, INTRAVASCULAR, CARDIOVASCULAR, Filters, Vena Cava, Greenfield Filters, Filters, Greenfield, filter vena cava inferior, inferior vena cava filter, vena cava filter, vena cava filters, cava filter vena, inferior vena cava filters, Vena Cava Filters, Vena cava filter, Vena cava filter (physical object) |
| Swedish | Vena cava-filter |
| Czech | filtry endokavální, vena cava - filtry, kavální filtry |
| Finnish | Onttolaskimosuodattimet |
| Russian | POLAIA VENA, FIL'TRY, FIL'TRY ZONTICHNYE DLIA NIZHNEI POLOI VENY, KAVA-FIL'TRY, POLAIA VENA NIZHNIAIA, LECHEBNYE FIL'TRY, КАВА-ФИЛЬТРЫ, ПОЛАЯ ВЕНА НИЖНЯЯ, ЛЕЧЕБНЫЕ ФИЛЬТРЫ, ПОЛАЯ ВЕНА, ФИЛЬТРЫ, ФИЛЬТРЫ ЗОНТИЧНЫЕ ДЛЯ НИЖНЕЙ ПОЛОЙ ВЕНЫ |
| Japanese | 下大静脈フィルター, 大静脈ろ過装置, 傘フィルター, 下大静脈フィルタ, 下大静脈ろ過装置, 大静脈フィルタ, 傘フィルタ, 大静脈フィルター |
| Italian | Filtro della vena cava inferiore, Filtri della vena cava inferiore, Filtri della vena cava |
| French | Filtres caves, Filtres de la veine cave inférieure, Filtres de la veine cave |
| Polish | Filtry żyły głównej |
| Norwegian | Vena cava-filter, Vena cava inferior-filter |
| Spanish | filtro para vena cava (objeto físico), filtro para vena cava, Filtros de la Vena Cava Inferior, Filtros de Vena Cava |
| German | Vena-cava-Filter, Vena-cava-inferior-Filter |
| Dutch | Vena-cava-inferiorfilter, Vena-cavafilter, Vena-cavafilters |
| Portuguese | Filtros da Veia Cava Inferior, Filtros de Veia Cava |
Ontology: Greenfield filter (C0175753)
| Concepts | Medical Device (T074) |
| SnomedCT | 79051006 |
| English | Greenfield filter, device, filter greenfield, greenfield filters, greenfield filter, Greenfield filter, Greenfield filter, device (physical object) |
| Spanish | filtro de Greenfield (objeto físico), filtro de Greenfield |
