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).