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Current Controversies in Inferior Vena Cava Filter Placement
- Source :
- AJR. American journal of roentgenology. 216(3)
- Publication Year :
- 2020
-
Abstract
- Despite inferior vena cava (IVC) filter practice spanning over 50 years, interventionalists face many controversies in proper utilization and management. This article reviews recent literature and offers opinions on filter practices. IVC filtration is most likely to benefit patients at high risk of iatrogenic pulmonary embolus during endovenous intervention. Filters should be used selectively in patients with acute trauma or who are undergoing bariatric surgery. Retrieval should be attempted for perforating filter and fractured filter fragments when imaging suggests feasibility and favorable risk-to-benefit ratio. Antibiotic prophylaxis should be considered when removing filters with confirmed gastrointestinal penetration. Anticoagulation solely because of filter presence is not recommended except in patients with active malignancy. Anticoagulation while filters remain in place may decrease long-term filter complications in these patients. Patients with a filter and symptomatic IVC occlusion should be offered filter removal and IVC reconstruction. Physicians implanting filters may maximize retrieval by maintaining physician-patient relationships and scheduling follow-up at time of placement. Annual follow-up allows continued evaluation for removal or replacement as appropriate. Advanced retrieval techniques increase retrieval rates but require caution. Certain cases may require referral to experienced centers with additional retrieval resources. The views expressed should help guide clinical practice, future innovation, and research.
- Subjects :
- Venous Thrombosis
Physician-Patient Relations
Vena Cava Filters
Endovascular Procedures
Anticoagulants
Bariatric Surgery
COVID-19
Vena Cava, Inferior
Antibiotic Prophylaxis
Prosthesis Design
Risk Assessment
Prosthesis Implantation
Recurrence
Neoplasms
Practice Guidelines as Topic
Humans
Wounds and Injuries
Pulmonary Embolism
Device Removal
Subjects
Details
- ISSN :
- 15463141
- Volume :
- 216
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- AJR. American journal of roentgenology
- Accession number :
- edsair.pmid..........34a74e6bc02bfcbc2aff15a21c544cbc