1. The law of unintended consequences: current design challenges in inferior vena cava filters
- Author
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Kimi L. Kondo, Jonathan Lindquist, Kristofer Schramm, Robert J. Lewandowski, D. Thor Johnson, Audrey Magnowski, Matthew A. Brown, Robert K. Ryu, Kush R. Desai, and Paul J. Rochon
- Subjects
medicine.medical_specialty ,Vena Cava Filters ,Deep vein ,Biomedical Engineering ,Inferior vena cava filter ,030204 cardiovascular system & hematology ,Prosthesis Design ,Inferior vena cava ,03 medical and health sciences ,0302 clinical medicine ,Venous thromboembolic disease ,Thromboembolism ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Device Removal ,Venous Thrombosis ,business.industry ,General Medicine ,History, 20th Century ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Surgery ,medicine.anatomical_structure ,medicine.vein ,Radiology ,business ,Pulmonary Embolism - Abstract
Venous thromboembolic disease (VTD) encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE) is a commonly encountered condition with potentially fatal sequelae. When unable to be adequately anticoagulated, patients require a mechanical means to prevent PE. This review discusses the history of inferior vena cava interruption and the development of inferior vena cava filters (IVCF). Areas covered: Milestone innovations in the mechanical treatment of VTD, their successes and shortcomings are discussed. The unforeseen complications that have occurred with implantation of IVCF have a profound impact on the present utilization of retrievable filters. Particular attention is dedicated to the evidence for safe and effective use of IVCF and the challenges presented to further improvement of these technologies. Expert commentary: While evidence suggests that IVCF are effective in preventing PE, the recent 'de-volution' from permanent to retrievable design has unleashed an epidemic device-related complications. Retrievable filter design is reliant on a 'Goldilocks' premise: make the device stable (so it doesn't migrate), but not too stable (so you can still retrieve it). Efforts must be aimed at optimizing utilization using decision support tools, meticulous follow up after deployment, and conversion from retrievable to permanent devices if the patient requires lifelong mechanical prophylaxis.
- Published
- 2017