Elsevier

Journal of Vascular Surgery

Volume 49, Issue 2, February 2009, Pages 410-416
Journal of Vascular Surgery

Clinical research study
From the Society for Vascular Surgery
The use of retrievable inferior vena cava filters in severely injured military trauma patients

Presented at the Annual Meeting of the Society for Vascular Surgery, San Diego, Calif, Jun 5-8, 2008.
https://doi.org/10.1016/j.jvs.2008.09.004Get rights and content
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Objective

Important recent data on retrievable inferior vena cava filter (R-IVCF) used in civilian trauma centers suffer from poor follow-up in these transient patients. Because US military casualties can be more easily followed globally, our objective was to further characterize R-IVCF outcomes in a trauma population with improved follow-up.

Methods

From July 2003 to June 2007, trauma registry records were retrospectively reviewed for US soldiers injured in Iraq and Afghanistan who had R-IVCF placement. Indications, type of filter, complications, outcomes, and retrieval data were analyzed.

Results

Seventy-two R-IVCFs were placed during the study period. Mean follow-up was 28.0 ± 12.0 months, in 61 (85%) patients. Mean injury severity score (ISS) was 36.3 ± 10.4 and mean patient age was 27.4 ± 6.4 years. Fifty-nine R-IVCFs (82%) were not retrieved due to: death (1, 1.3%), technical failure (2, 2.8%), lost to follow-up (11, 15.2%), or contraindications to retrieval (45, 62.5%). Thirteen R-IVCFs were successfully removed, an overall retrieval rate of 18%. Median dwell time of those removed was 47 days (range, 10-94). IVCF indications were prophylactic in 23 (32%) and therapeutic in 49 (68%) cases. Both retrieval failures were due to incorporation into the caval wall, attempted at 90 and 156 days. Deep vein thromboses at the insertion site or pulmonary embolism following R-IVCF placement or removal were not observed. To date, there have been no reports of IVC stenosis or occlusion.

Conclusion

R-IVCFs were safely and effectively used in severely injured military trauma patients with high ISS. Despite improved follow-up, overall retrieval remained low, reflecting the civilian experience. Indication, rather than follow-up losses, accounted for the low retrieval rate. Practice patterns for R-IVCF in trauma may need to be re-examined to optimize outcomes.

Cited by (0)

Investigation performed at Walter Reed Army Medical Center, Washington, DC.

Competition of interest: none.

Disclaimer: The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the United States Army or the Department of Defense. All authors are employees of the United States government.

CME article