Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-jbqgn Total loading time: 0 Render date: 2024-06-17T11:02:46.870Z Has data issue: false hasContentIssue false

80 - Inferior vena cava filters

Published online by Cambridge University Press:  12 January 2010

Sunil S. Rayan
Affiliation:
Emory University, School of Medicine, Atlanta, GA
Thomas F. Dodson
Affiliation:
Emory University, School of Medicine, Atlanta, GA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
Get access

Summary

Pulmonary embolism (PE) accounts for 150 000 to 200 000 deaths per year in the USA. Although anticoagulation is the standard of care for PE, up to 1.5% of patients on anticoagulation suffer a subsequent fatal PE. Recurrent PE despite adequate anticoagulation, contraindication to anticoagulation, and bleeding complications of anticoagulation therapy are all accepted indications for caval interruption. The introduction of inferior vena caval (IVC) filters have revolutionized interruption procedures, which have existed since the nineteenth century. Since the original Mobin–Uddin umbrella filter was described over 30 years ago there have been many technological advances, the most significant thus far being the Greenfield filter, introduced in 1973, which overcame many of the original device's shortcomings and is the most commonly used filter today.

IVC filters are now inserted percutaneously under local anesthesia via the femoral or jugular approach, usually in less than 30 minutes. The procedure consists of achieving central venous access, venography, and device deployment. Venography is usually accomplished with a minimum of contrast and is used to size the IVC, locate the renal veins, and identify possibly aberrant anatomy. Procedural morbidity is extremely rare and consists primarily of complications at the insertion site. Long-term complications are more significant and need to be considered when placing filters in young patients. Such complications include device migration, device fracture, caval thrombosis, and lower extremity edema.

Multiple permanent devices are currently approved by the Food and Drug Administration for use in PE prevention: Greenfield® (Boston Scientific, Natick, MA), Bird's Nest® (Cook Inc., Bloomington, IN), Trapease® (Cordis Endovascular, Warren, NJ), LGM Vena-Tech and Vena-Tech LP® (B. Braun, Evanston, IL) and Simon-Nitinol® (C. R. Bard, Murray Hill, NJ).

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
, pp. 627 - 628
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Becker, D. M., Philbrick, J. T., & Selby, J. B.Inferior vena cava filters: indications, safety, effectiveness. Arch. Intern. Med. 1992; 152: 1985–1994.CrossRefGoogle ScholarPubMed
Douketis, J. D., Kearon, C., Bates, S.et al. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. J. Am. Med. Assoc. 1998; 279: 458–462.CrossRefGoogle ScholarPubMed
Greenfield, L. J. & Proctor, M. C.Twenty-year clinical experience with the Greenfield filter. Cardiovasc. Surg. 1995; 3: 199–205.CrossRefGoogle ScholarPubMed
Greenfield, L. J., McCurdy, J. R., Brown, P. P.et al. A new intracaval filter permitting continued flow and resolution of emboli. Surgery 1973; 73: 599–606.Google ScholarPubMed
Mohan, C. R., Hoballah, J. J., Sharp, W. J.et al. Comparative efficacy and complications of vena caval filters. J. Vasc. Surg. 1995; 21: 235–246.CrossRefGoogle ScholarPubMed
Roehm, J., Johnsrude, I., Barth, M.et al. The Bird's Nest inferior vena cava filter: progress report. Radiology 1988; 165: 745–749.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×