Optional Inferior Vena Cava Filters in the Trauma Patient

 

 Buy Article Permissions and Reprints

ABSTRACT

Trauma patients are at exceedingly high risk of development of venous thromboembolism (VTE) including deep venous thrombosis and pulmonary embolism (PE). The epidemiology of VTE in trauma patients is reviewed. PE is thought to be the third major cause of death after trauma in those patients who survive longer than 24 hours after onset of injury. In fact, patients recovering from trauma have the highest rate of VTE among all subgroups of hospitalized patients. Various prophylactic and surveillance methods have been evaluated and found helpful in certain situations, but VTE complications can occur despite such measures. Therapeutic and prophylactic uses of inferior vena cava (IVC) filters in trauma patients are reviewed. Prophylactic IVC filter use is revealed to be a controversial subject with valid arguments on both sides of the issue. With the lack of prospective randomized trials of IVC filter use in trauma, it is impossible to make evidence-based recommendations. Unfortunately, two sets of guidelines are available for insertion of filters in trauma patients, with conflicting recommendations. The introduction of retrievable IVC filters seems to offer a unique solution for VTE protection in the trauma patient population, which often consists of younger members of our population. Lastly, current generations of FDA-approved retrieval filters are discussed.

REFERENCES

• 1 Shackford S R, Davis J W, Hollingsworth-Fridlund P et al.. Venous thromboembolism in patients with major trauma.  Am J Surg. 1990;  159 365-369
  CrossrefPubMedGoogle Scholar
• 2 McCartney J. Pulmonary embolism following trauma.  Surg Gynecol Obstet. 1935;  61 369-379
  PubMedGoogle Scholar
• 3 Sevitt S, Gallagher N. Venous thrombosis and pulmonary embolism. A clinico-pathological study in injured and burned patients.  Br J Surg. 1961;  48 475-489
  CrossrefPubMedGoogle Scholar
• 4 Sevitt S, Gallagher N G. Prevention of venous thrombosis and pulmonary embolism in injured patients. A trial of anticoagulant prophylaxis with phenindione in middle-aged and elderly patients with fractured necks of femur.  Lancet. 1959;  2 981-989
  PubMedGoogle Scholar
• 5 Fitts Jr W T, Lehr H B, Bitner R L, Spelman J W. An analysis of 950 fatal injuries.  Surgery. 1964;  56 663-668
  PubMedGoogle Scholar
• 6 Coon W W. Risk factors in pulmonary embolism.  Surg Gynecol Obstet. 1976;  143 385-390
  PubMedGoogle Scholar
• 7 Knudson M M, Collins J A, Goodman S B, McCrory D W, Hoyt D B, Mackersie R C. Thromboembolism following multiple trauma.  J Trauma. 1992;  32 2-11
  CrossrefPubMedGoogle Scholar
• 8 Geerts W H, Code K I, Jay R M, Chen E, Szalai J P. A prospective study of venous thromboembolism after major trauma.  N Engl J Med. 1994;  331 1601-1606
  CrossrefPubMedGoogle Scholar
• 9 Adams R C, Hamrick M, Berenguer C, Senkowski C, Ochsner M G. Four years of an aggressive prophylaxis and screening protocol for venous thromboembolism in a large trauma population.  J Trauma. 2008;  65 300-306 discussion 306-308
  CrossrefPubMedGoogle Scholar
• 10 Knudson M M, Ikossi D G. Venous thromboembolism after trauma.  Curr Opin Crit Care. 2004;  10 539-548
  CrossrefPubMedGoogle Scholar
• 11 Rogers F B. Venous thromboembolism in trauma patients: a review.  Surgery. 2001;  130 1-12
  CrossrefPubMedGoogle Scholar
• 12 Dennis J W, Menawat S, Von Thron J et al.. Efficacy of deep venous thrombosis prophylaxis in trauma patients and identification of high-risk groups.  J Trauma. 1993;  35 132-138 discussion 138-139
  CrossrefPubMedGoogle Scholar
• 13 Velmahos G C, Kern J, Chan L S, Oder D, Murray J A, Shekelle P. Prevention of venous thromboembolism after injury: an evidence-based report—part I: analysis of risk factors and evaluation of the role of vena caval filters.  J Trauma. 2000;  49 132-138 discussion 139
  CrossrefPubMedGoogle Scholar
• 14 Rogers F B, Cipolle M D, Velmahos G, Rozycki G, Luchette F A. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group.  J Trauma. 2002;  53 142-164
  CrossrefPubMedGoogle Scholar
• 15 Jacobs D G, Piotrowski J J, Hoppensteadt D A, Salvator A E, Fareed J. Hemodynamic and fibrinolytic consequences of intermittent pneumatic compression: preliminary results.  J Trauma. 1996;  40 710-716 discussion 716-717
  CrossrefPubMedGoogle Scholar
• 16 Hoff W S, Hoey B A, Wainwright G A et al.. Early experience with retrievable inferior vena cava filters in high-risk trauma patients.  J Am Coll Surg. 2004;  199 869-874
  CrossrefPubMedGoogle Scholar
• 17 Bjarnason H. Commentary on “Retrievable IVC filters: a decision matrix for appropriate utilization”.  Perspect Vasc Surg Endovasc Ther. 2006;  18 17-18
  CrossrefPubMedGoogle Scholar
• 18 Rogers F, Rebuck J A, Sing R F. Venous thromboembolism in trauma: an update for the intensive care unit practitioner.  J Intensive Care Med. 2007;  22 26-37
  CrossrefPubMedGoogle Scholar
• 19 Fullen W D, Miller E H, Steele W F, McDonough J J. Prophylactic vena caval interruption in hip fractures.  J Trauma. 1973;  13 403-410
  CrossrefPubMedGoogle Scholar
• 20 Thomas III W O, Ferrara J J, Rodning C B. A retrospective analysis of inferior vena caval filtration for prevention of pulmonary embolization.  Am Surg. 1988;  54 726-730
  PubMedGoogle Scholar
• 21 Rohrer M J, Scheidler M G, Wheeler H B, Cutler B S. Extended indications for placement of an inferior vena cava filter.  J Vasc Surg. 1989;  10 44-49 discussion 49-50
  CrossrefPubMedGoogle Scholar
• 22 Webb L X, Rush P T, Fuller S B, Meredith J W. Greenfield filter prophylaxis of pulmonary embolism in patients undergoing surgery for acetabular fracture.  J Orthop Trauma. 1992;  6 139-145
  CrossrefPubMedGoogle Scholar
• 23 Wilson J T, Rogers F B, Wald S L, Shackford S R, Ricci M A. Prophylactic vena cava filter insertion in patients with traumatic spinal cord injury: preliminary results.  Neurosurgery. 1994;  35 234-239 discussion 239
  CrossrefPubMedGoogle Scholar
• 24 Rosenthal D, McKinsey J F, Levy A M, Lamis P A, Clark M D. Use of the Greenfield filter in patients with major trauma.  Cardiovasc Surg. 1994;  2 52-55
  PubMedGoogle Scholar
• 25 Winchell R J, Hoyt D B, Walsh J C, Simons R K, Eastman A B. Risk factors associated with pulmonary embolism despite routine prophylaxis: implications for improved protection.  J Trauma. 1994;  37 600-606
  CrossrefPubMedGoogle Scholar
• 26 Leach T A, Pastena J A, Swan K G, Tikellis J I, Blackwood J M, Odom J W. Surgical prophylaxis for pulmonary embolism.  Am Surg. 1994;  60 292-295
  PubMedGoogle Scholar
• 27 Khansarinia S, Dennis J W, Veldenz H C, Butcher J L, Hartland L. Prophylactic Greenfield filter placement in selected high-risk trauma patients.  J Vasc Surg. 1995;  22 231-235 discussion 235-236
  CrossrefPubMedGoogle Scholar
• 28 Rogers F B, Shackford S R, Ricci M A, Wilson J T, Parsons S. Routine prophylactic vena cava filter insertion in severely injured trauma patients decreases the incidence of pulmonary embolism.  J Am Coll Surg. 1995;  180 641-647
  PubMedGoogle Scholar
• 29 Patton Jr J H, Fabian T C, Croce M A, Minard G, Pritchard F E, Kudsk K A. Prophylactic Greenfield filters: acute complications and long-term follow-up.  J Trauma. 1996;  41 231-236 discussion 236-237
  CrossrefPubMedGoogle Scholar
• 30 Rodriguez J L, Lopez J M, Proctor M C et al.. Early placement of prophylactic vena caval filters in injured patients at high risk for pulmonary embolism.  J Trauma. 1996;  40 797-802 discussion 802-804
  CrossrefPubMedGoogle Scholar
• 31 Nunn C R, Neuzil D, Naslund T et al.. Cost-effective method for bedside insertion of vena caval filters in trauma patients.  J Trauma. 1997;  43 752-758
  CrossrefPubMedGoogle Scholar
• 32 Gosin J S, Graham A M, Ciocca R G, Hammond J S. Efficacy of prophylactic vena cava filters in high-risk trauma patients.  Ann Vasc Surg. 1997;  11 100-105
  CrossrefPubMedGoogle Scholar
• 33 Headrick Jr J R, Barker D E, Pate L M, Horne K, Russell W L, Burns R P. The role of ultrasonography and inferior vena cava filter placement in high-risk trauma patients.  Am Surg. 1997;  63 1-8
  PubMedGoogle Scholar
• 34 Rogers F B, Shackford S R, Ricci M A, Huber B M, Atkins T. Prophylactic vena cava filter insertion in selected high-risk orthopaedic trauma patients.  J Orthop Trauma. 1997;  11 267-272
  CrossrefPubMedGoogle Scholar
• 35 Rogers F B, Strindberg G, Shackford S R et al.. Five-year follow-up of prophylactic vena cava filters in high-risk trauma patients.  Arch Surg. 1998;  133 406-411 discussion 412
  CrossrefPubMedGoogle Scholar
• 36 Langan 3rd E M, Miller R S, Casey 3rd W J, Carsten 3rd C G, Graham R M, Taylor S M. Prophylactic inferior vena cava filters in trauma patients unable to receive standard venous thromboembolism prophylaxis.  J Vasc Surg. 1999;  30 484-488
  CrossrefPubMedGoogle Scholar
• 37 Hughes G C, Smith T P, Eachempati S R, Vaslef S N, Reed II R L. The use of a temporary vena caval interruption device in high-risk trauma patients unable to receive standard venous thromboembolism prophylaxis.  J Trauma. 1999;  46 246-249
  CrossrefPubMedGoogle Scholar
• 38 McMurtry A L, Owings J T, Anderson J T, Battistella F D, Gosselin R. Increased use of prophylactic vena cava filters in trauma patients failed to decrease overall incidence of pulmonary embolism.  J Am Coll Surg. 1999;  189 314-320
  CrossrefPubMedGoogle Scholar
• 39 Wojcik R, Cipolle M D, Fearen I, Jaffe J, Newcomb J, Pasquale M D. Long-term follow-up of trauma patients with a vena caval filter.  J Trauma. 2000;  49 839-843
  CrossrefPubMedGoogle Scholar
• 40 Sekharan J, Dennis J W, Miranda F E et al.. Long-term follow-up of prophylactic Greenfield filters in multisystem trauma patients.  J Trauma. 2001;  51 1087-1090 discussion 1090-1091
  CrossrefPubMedGoogle Scholar
• 41 Rosenthal D, Wellons E D, Levitt A B, Shuler F W, O’Conner R E, Henderson V J. Role of prophylactic temporary inferior vena cava filters placed at the ICU bedside under intravascular ultrasound guidance in patients with multiple trauma.  J Vasc Surg. 2004;  40 958-964
  CrossrefPubMedGoogle Scholar
• 42 Morris C S, Rogers F B, Najarian K E, Bhave A D, Shackford S R. Current trends in vena caval filtration with the introduction of a retrievable filter at a level I trauma center.  J Trauma. 2004;  57 32-36
  CrossrefPubMedGoogle Scholar
• 43 Allen T L, Carter J L, Morris B J, Harker C P, Stevens M H. Retrievable vena cava filters in trauma patients for high-risk prophylaxis and prevention of pulmonary embolism.  Am J Surg. 2005;  189 656-661
  CrossrefPubMedGoogle Scholar
• 44 Antevil J L, Sise M J, Sack D I et al.. Retrievable vena cava filters for preventing pulmonary embolism in trauma patients: a cautionary tale.  J Trauma. 2006;  60 35-40
  CrossrefPubMedGoogle Scholar
• 45 Meier C, Keller I S, Pfiffner R, Labler L, Trentz O, Pfammatter T. Early experience with the retrievable OptEase vena cava filter in high-risk trauma patients.  Eur J Vasc Endovasc Surg. 2006;  32 589-595
  CrossrefPubMedGoogle Scholar
• 46 Rosenthal D, Wellons E D, Lai K M, Bikk A, Henderson V J. Retrievable inferior vena cava filters: initial clinical results.  Ann Vasc Surg. 2006;  20 157-165
  CrossrefPubMedGoogle Scholar
• 47 Karmy-Jones R, Jurkovich G J, Velmahos G C et al.. Practice patterns and outcomes of retrievable vena cava filters in trauma patients: an AAST multicenter study.  J Trauma. 2007;  62 17-24 discussion 24-25
  CrossrefPubMedGoogle Scholar
• 48 Cherry R A, Nichols P A, Snavely T M, David M T, Lynch F C. Prophylactic inferior vena cava filters: do they make a difference in trauma patients?.  J Trauma. 2008;  65 544-548
  CrossrefPubMedGoogle Scholar
• 49 Johnson III O N, Gillespie D L, Aidinian G, White P W, Adams E, Fox C J. The use of retrievable inferior vena cava filters in severely injured military trauma patients.  J Vasc Surg. 2009;  49 410-416 discussion 416
  CrossrefPubMedGoogle Scholar
• 50 Decousus H, Leizorovicz A, Parent F et al.. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group.  N Engl J Med. 1998;  338 409-415
  CrossrefPubMedGoogle Scholar
• 51 PREPIC Study Group . Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study.  Circulation. 2005;  112 416-422
  CrossrefPubMedGoogle Scholar
• 52 Velmahos G C, Kern J, Chan L S, Oder D, Murray J A, Shekelle P. Prevention of venous thromboembolism after injury: an evidence-based report—part II: analysis of risk factors and evaluation of the role of vena caval filters.  J Trauma. 2000;  49 140-144
  CrossrefPubMedGoogle Scholar
• 53 Girard T D, Philbrick J T, Fritz Angle J, Becker D M. Prophylactic vena cava filters for trauma patients: a systematic review of the literature.  Thromb Res. 2003;  112 261-267
  CrossrefPubMedGoogle Scholar
• 54 Brasel K J, Borgstrom D C, Weigelt J A. Cost-effective prevention of pulmonary embolus in high-risk trauma patients.  J Trauma. 1997;  42 456-460 discussion 460-462
  CrossrefPubMedGoogle Scholar
• 55 Spain D A, Richardson J D, Polk Jr H C, Bergamini T M, Wilson M A, Miller F B. Venous thromboembolism in the high-risk trauma patient: do risks justify aggressive screening and prophylaxis?.  J Trauma. 1997;  42 463-467 discussion 467-469
  CrossrefPubMedGoogle Scholar
• 56 Geerts W H, Bergqvist D, Pineo G F American College of Chest Physicians et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).  Chest. 2008;  133(6 Suppl) 381S-453S
  CrossrefPubMedGoogle Scholar
• 57 Singh P, Lai H M, Lerner R G, Chugh T, Aronow W S. Guidelines and the use of inferior vena cava filters: a review of an institutional experience.  J Thromb Haemost. 2009;  7 65-71
  PubMedGoogle Scholar
• 58 Oppat W F, Chiou A C, Matsumura J S. Intravascular ultrasound-guided vena cava filter placement.  J Endovasc Surg. 1999;  6 285-287
  CrossrefPubMedGoogle Scholar
• 59 Matsuura J H, White R A, Kopchok G et al.. Vena caval filter placement by intravascular ultrasound.  Cardiovasc Surg. 2001;  9 571-574
  CrossrefPubMedGoogle Scholar
• 60 Wellons E D, Matsuura J H, Shuler F W, Franklin J S, Rosenthal D. Bedside intravascular ultrasound-guided vena cava filter placement.  J Vasc Surg. 2003;  38 455-457
  CrossrefPubMedGoogle Scholar
• 61 Van Natta T L, Morris Jr J A, Eddy V A et al.. Elective bedside surgery in critically injured patients is safe and cost-effective.  Ann Surg. 1998;  227 618-624 discussion 624-626
  CrossrefPubMedGoogle Scholar
• 62 Sato D T, Robinson K D, Gregory R T et al.. Duplex directed caval filter insertion in multi-trauma and critically ill patients.  Ann Vasc Surg. 1999;  13 365-371
  CrossrefPubMedGoogle Scholar
• 63 Danetz J S, McLafferty R B, Ayerdi J, Gruneiro L A, Ramsey D E, Hodgson K J. Selective venography versus nonselective venography before vena cava filter placement: evidence for more, not less.  J Vasc Surg. 2003;  38 928-934
  CrossrefPubMedGoogle Scholar
• 64 Kaufman J A, Kinney T B, Streiff M B et al.. Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference.  J Vasc Interv Radiol. 2006;  17 449-459
  CrossrefPubMedGoogle Scholar
• 65 Schmelzer T M, Christmas A B, Taylor D A, Heniford B T, Sing R F. Vena cava filter retrieval in therapeutically anticoagulated patients.  Am J Surg. 2008;  196 944-946 discussion 946-947
  CrossrefPubMedGoogle Scholar
• 66 Sing R F, Camp S M, Heniford B T et al.. Timing of pulmonary emboli after trauma: implications for retrievable vena cava filters.  J Trauma. 2006;  60 732-734 discussion 734-735
  CrossrefPubMedGoogle Scholar
• 67 Van Ha T G, Vinokur O, Lorenz J et al.. Techniques used for difficult retrievals of the Günther Tulip inferior vena cava filter: experience in 32 patients.  J Vasc Interv Radiol. 2009;  20 92-99
  CrossrefPubMedGoogle Scholar
• 68 Kuo W T, Bostaph A S, Loh C T, Frisoli J K, Kee S T. Retrieval of trapped Günther Tulip inferior vena cava filters: snare-over-guide wire loop technique.  J Vasc Interv Radiol. 2006;  17(11 Pt 1) 1845-1849
  CrossrefPubMedGoogle Scholar
• 69 Stavropoulos S W, Dixon R G, Burke C T et al.. Embedded inferior vena cava filter removal: use of endobronchial forceps.  J Vasc Interv Radiol. 2008;  19 1297-1301
  CrossrefPubMedGoogle Scholar
• 70 Kinney T B. Update on inferior vena cava filters.  J Vasc Interv Radiol. 2003;  14 425-440
  CrossrefPubMedGoogle Scholar
• 71 Keeling A N, Kinney T B, Lee M J. Optional inferior vena caval filters: where are we now?.  Eur Radiol. 2008;  18 1556-1568
  CrossrefPubMedGoogle Scholar
• 72 Rimon U, Volkov A, Garniek A et al.. Histology of tissue adherent to OptEase inferior vena cava filters regarding indwelling time.  Cardiovasc Intervent Radiol. 2009;  32 93-96
  CrossrefPubMedGoogle Scholar

Thomas B KinneyM.D. M.S.M.E. 

Professor of Clinical Radiology

200 West Arbor Drive, San Diego, CA 92103-8756

Email: tbkinney@ucsd.edu