Cath Lab Digest

More than 200,000 IVC filters were inserted in the U.S. in 2010, which is an enormous number that represents exponential growth when compared with previous decades. Such “sea-change” can be explained on the basis of several factors, including the general evolution of medical practice in this country. But principally, it is a reflection of newer and better IVC filter technologies and devices – particularly, the promise of retrievability.

It’d be hard to blame clinicians for embracing filter placement enthusiastically and aggressively when today’s devices are characterized as temporary filters: they do their job preventing fatal pulmonary emboli (PE), and then the filter can be removed weeks or months later once the risks have abated—leaving nothing behind. Sounds good, doesn’t it? Unfortunately, the reality has not quite conformed to such designs: only a small minority of such filters is ever retrieved, thus becoming permanent implants. The resultant steep rise in IVC filter placements has led to more frequent procedure- and device-related complications: filter migration and thrombosis, IVC thrombosis and perforations, strut fractures, and other problems are being reported more commonly at present. Furthermore, many such filters are being placed prophylactically, that is, on patients who do not have documented venous thrombosis or PE—an off-label use of these devices.

Both the medical community at large and interventional specialists are clearly in need of more precise evidence-based guidance in these matters. This may not be forthcoming for several years. In the meantime, caution and a more conservative attitude may be most appropriate at the time of recommending and inserting such IVC filters, pondering the real clinical need and potential problems down the road.

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Dr. Frank J Criado is a Board-Certified Vascular Surgeon and Endovascular Specialist at the Union Memorial Hospital-MedStar Health in Baltimore, Maryland – USA.

Dr. Criado is widely acknowledged to be a pioneer in endovascular therapy, with a 20-year + interventional experience. He has contributed extensively to the literature with more than 100 peer-reviewed published articles – mostly on various vascular and endovascular subjects, and Editor-in-Chief of Vascular Disease Management (VDM). He has also been active in clinical research, with a major focus on aortic stent-graft and carotid interventions, and endovascular technologies in general. He was the National Principal Investigator (P.I.) for the Medtronic Talent AAA clinical trials in the U.S., and a member of the Executive Committee for the Medtronic Valor Thoracic trial.

He is a founding member and immediate past President of the International Society of Endovascular Specialists (ISES), founder and current President of the endovascular surgery society of Latinamerica (CELA), and a member of all major U.S. and international vascular and endovascular societies. He is a Fellow of the American College of Surgeons (FACS) and of the Society of Vascular Medicine (FSVM), and a member of the Board of Directors of the Society for Vascular Surgery (SVS).