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The Prophylactic Use of Inferior Vena Cava Filters in Patients Undergoing High-Risk Spinal Surgery

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Annals of Vascular Surgery

Abstract

Prophylactic inferior vena cava filter (IVCF) placement is advocated in some high-risk groups. We sought data regarding safety and efficacy for prophylactic IVCF placement in patients at high risk for venous thromboembolism (VTE) following major spinal reconstruction. Seventy-four spine surgery patients with contraindication to anticoagulation (44 females, 30 males; mean age 56.2) received prophylactic IVCFs. Criteria were (1) history of thromboembolism, (2) diagnosed thrombophilia, (3) malignancy, (4) bedridden >2 weeks prior to surgery, (5) staged procedures or multiple levels, (6) combined anterior/posterior approaches, (7) expected need for significant iliocaval manipulation during exposure, and (8) single-stage anesthetic time >8 hr. Seventy patients had at least two risk factors. All received IVCFs prior to the first stage of spine reconstruction. Patients were evaluated for filter complications, deep vein thrombosis (DVT), and pulmonary embolism (PE). Patients’ lower extremity veins from groin to ankle were imaged weekly until discharge using duplex ultrasound (DUS). One-third also underwent thoracic and pelvic computed tomography scans, and the pelvic veins, IVC, and pulmonary vasculature were evaluated for VTE. Multiple DUS (n = 198, mean 2.6 studies per patient) were performed in 68 patients. At a mean follow-up of 11 months, one of the patients developed PE. Twenty-seven limbs in 23 patients developed DVT. Five limbs had isolated calf DVT, and 22 had proximal vein involvement. Insertion site DVT accounted for nearly one-third of the DVTs. Six patients died from unrelated complications. There was one technical error with an IVCF deployed in the iliac vein. Despite a high incidence of DVT following high-risk spinal surgery, prophylactic IVCF placement appears to protect patients from PE.

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References

  1. FA Anderson SuffixJr HB Wheeler RJ Goldberg et al. (1991) ArticleTitleA population based perspective of the hospital incidence and case fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study Arch Intern Med 151 933–938 Occurrence Handle10.1001/archinte.151.5.933 Occurrence Handle2025141

    Article  PubMed  Google Scholar 

  2. P Kaboli MC Henderson RH White (2003) ArticleTitleDVT prophylaxis and anticoagulation in the surgical patient Med Clin North Am 87 77–110 Occurrence Handle10.1016/S0025-7125(02)00144-X Occurrence Handle1:CAS:528:DC%2BD3sXhsFOjurw%3D Occurrence Handle12575885

    Article  CAS  PubMed  Google Scholar 

  3. D Bergqvist (1994) ArticleTitleThe role of vena caval interruption in patients with venous thromboembolism Prog Cardiovasc Dis 37 25–37 Occurrence Handle1:STN:280:ByuB1MvmtFQ%3D Occurrence Handle8022984

    CAS  PubMed  Google Scholar 

  4. RH White H Zhou J Kim et al. (2000) ArticleTitleA population-based study of the effectiveness of inferior vena cava filter use among patients with venous thromboembolism Arch Intern Med 160 2033–2041 Occurrence Handle10.1001/archinte.160.13.2033 Occurrence Handle1:STN:280:DC%2BD3czkslKnuw%3D%3D Occurrence Handle10888977

    Article  CAS  PubMed  Google Scholar 

  5. FB Rogers SR Shackford MA Ricci et al. (1995) ArticleTitleRoutine prophylactic vena cava filter insertion in severely injured trauma patients decreases the incidence of pulmonary embolism J Am Coll Surg 180 641–647 Occurrence Handle1:STN:280:ByqB1M7ltlU%3D Occurrence Handle7773475

    CAS  PubMed  Google Scholar 

  6. GC Velmahos J Kern LS Chan et al. (2000) ArticleTitlePrevention 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 49 132–138 Occurrence Handle1:STN:280:DC%2BD3czoslOltw%3D%3D Occurrence Handle10912869

    CAS  PubMed  Google Scholar 

  7. GC Velmahos J Kern LS Chan et al. (2000) ArticleTitlePrevention 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 49 140–144 Occurrence Handle1:STN:280:DC%2BD3czoslOltA%3D%3D Occurrence Handle10912870

    CAS  PubMed  Google Scholar 

  8. JS Gosin AM Graham RG Ciocca JS Hammond (1997) ArticleTitleEfficacy of prophylactic vena cava filters in high-risk trauma patients Ann Vasc Surg 11 100–105 Occurrence Handle1:STN:280:ByiB3MvnslM%3D Occurrence Handle9061147

    CAS  PubMed  Google Scholar 

  9. RA Maxwell M Chavarria-Aguilar WT Cockerham et al. (2002) ArticleTitleRoutine prophylactic vena cava filtration is not indicated after acute spinal cord injury J Trauma 52 902–906 Occurrence Handle11988656

    PubMed  Google Scholar 

  10. AM Carlin JG Tyburski RF Wilson C Steffes (2002) ArticleTitleProphylactic and therapeutic inferior vena cava filters to prevent pulmonary emboli in trauma patients Arch Surg 137 521–527 Occurrence Handle11982463

    PubMed  Google Scholar 

  11. JT Dearborn SS Hu CB Tribus DS Bradford (1999) ArticleTitleThromboembolic complications after major thoracolumbar spine surgery Spine 24 1471–1476 Occurrence Handle10423793 Occurrence Handle1:STN:280:DyaK1Mzlt1GqsA%3D%3D

    PubMed  CAS  Google Scholar 

  12. KD Calligaro WS Bergan MJ Haut et al. (1991) ArticleTitleThromboembolic complications in patients with advanced cancer: anticoagulation versus Greenfield filter placement Ann Vasc Surg 5 186–189 Occurrence Handle1:STN:280:By6C1MjmvV0%3D Occurrence Handle2015191

    CAS  PubMed  Google Scholar 

  13. JR Cohen N Tenenbaum M Citron (1991) ArticleTitleGreenfield filter as primary therapy for deep venous thrombosis and/or pulmonary embolism in patients with cancer Surgery 109 12–15 Occurrence Handle1:STN:280:By6D1c7pt1Q%3D Occurrence Handle1984634

    CAS  PubMed  Google Scholar 

  14. University of Alabama at Birmingham/Spinal Cord Injury Information Network Website, http://www.spinalcord.uab. edu (accessed January 8, 2001)

  15. HJ Sugerman EL Sugerman L Wolfe et al. (2001) ArticleTitleRisks and benefits of gastric bypass in morbidly obese patients with severe venous stasis disease Ann Surg 234 41–46 Occurrence Handle1:STN:280:DC%2BD3MvhtVKqsg%3D%3D Occurrence Handle11460821

    CAS  PubMed  Google Scholar 

  16. T Duperier A Mosenthal KG Swan S Kaul (2003) ArticleTitleAcute complications associated with Greenfield filter insertion in high-risk trauma patients J Trauma 4 545–549 Occurrence Handle10.1097/00005373-200303000-00018

    Article  Google Scholar 

  17. H Galster G Kolb A Kohsytorz C Seidlmayer V Paal (2000) ArticleTitleThe pre-, peri-, and postsurgical activation of coagulation and the thromboembolic risk for different risk groups Thromb Res 100 381–388 Occurrence Handle1:CAS:528:DC%2BD3MXitlejtw%3D%3D Occurrence Handle11150579

    CAS  PubMed  Google Scholar 

  18. JH Scurr (1990) ArticleTitleHow long after surgery does the risk of thromboembolism persist? Acta Chir Scand Suppl 556 22–24 Occurrence Handle1:STN:280:By6C2czivV0%3D Occurrence Handle2288177

    CAS  PubMed  Google Scholar 

  19. MG Catre (1997) ArticleTitleAnticoagulation in spinal surgery. A critical review of the literature Can J Surg 40 413–419 Occurrence Handle1:STN:280:DyaK1c%2FnvVWmsA%3D%3D Occurrence Handle9416250

    CAS  PubMed  Google Scholar 

  20. SE Rokito MC Schwartz MG Neuwirth (1996) ArticleTitleDeep vein thrombosis after major reconstructive spinal surgery Spine 21 8539 Occurrence Handle10.1097/00007632-199604010-00016

    Article  Google Scholar 

  21. T Oda T Fuji Y Kato et al. (2000) ArticleTitleDeep venous thrombosis after posterior spinal surgery Spine 25 2962–2967 Occurrence Handle1:STN:280:DC%2BD38%2FgsFymtg%3D%3D Occurrence Handle11074685

    CAS  PubMed  Google Scholar 

  22. JE Tetzlaff HJ Yoon J O’Hara et al. (1994) ArticleTitleInfluence of anesthetic technique on the incidence of deep venous thrombosis after elective lumbar spine surgery Reg Anesth 19 IssueIDSuppl 28

    Google Scholar 

  23. JL West Suffix3rd LD Anderson (1992) ArticleTitleIncidence of deep vein thrombosis in major adult spinal surgery Spine 17 S254–S257 Occurrence Handle1523508

    PubMed  Google Scholar 

  24. MD Smith EL Bressler JE Lonstein R Winter MR Pinto F Denis (1994) ArticleTitleDeep venous thrombosis and pulmonary embolism after major reconstructive operations on the spine. A prospective analysis of three hundred and seventeen patients J Bone Joint Surg Am 76 980–985 Occurrence Handle1:STN:280:ByuB1MblvVM%3D Occurrence Handle8027126

    CAS  PubMed  Google Scholar 

  25. J Blebea R Wilson P Waybill et al. (1999) ArticleTitleDeep venous thrombosis after percutaneous insertion of vena caval filters J Vasc Surg 30 821–829 Occurrence Handle1:STN:280:DC%2BD3c%2FhvVaqtA%3D%3D Occurrence Handle10550179

    CAS  PubMed  Google Scholar 

  26. A Kantor S Glanz DH Gordon SJ Sclafani (1987) ArticleTitlePercutaneous insertion of the Kimray-Greenfield filter: incidence of femoral vein thrombosis A.J.R. Am J Roentgenol 149 1065–1066 Occurrence Handle1:STN:280:BieD2cnktFQ%3D

    CAS  Google Scholar 

  27. P Prandoni AW Lensing A Cogo et al. (1996) ArticleTitleThe long-term clinical course of acute deep venous thrombosis Ann Intern Med 125 1–7 Occurrence Handle1:STN:280:BymB2crgslE%3D Occurrence Handle8644983

    CAS  PubMed  Google Scholar 

  28. PY Marcy N Magne M Frenay JN Bruneton (2001) ArticleTitleRenal failure secondary to thrombotic complications of suprarenal inferior vena cava filter in cancer patients Cardiovasc Intervent Radiol 24 257–259 Occurrence Handle11779016 Occurrence Handle1:STN:280:DC%2BD38%2Flt1Cnsg%3D%3D

    PubMed  CAS  Google Scholar 

  29. PJ Offner A Hawkes R Madayag et al. (2003) ArticleTitleThe role of temporary inferior vena cava filters in critically ill surgical patients Arch Surg 138 591–595 Occurrence Handle12799328

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Loyola University Medical Center, Maywood, IL, USA

    Luis Leon MD, Heron Rodriguez MD & Nicos Labropoulos PhD

  2. Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, and Northwestern Memorial Hospital, Chicago, IL, USA

    Rabih G. Tawk MD & Stephen L. Ondra MD

  3. Division of Vascular Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, and Northwestern Memorial Hospital, Chicago, IL, USA

    Mark D. Morasch MD

Authors
  1. Luis Leon MD
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  2. Heron Rodriguez MD
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  3. Rabih G. Tawk MD
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  4. Stephen L. Ondra MD
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  5. Nicos Labropoulos PhD
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  6. Mark D. Morasch MD
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Corresponding author

Correspondence to Mark D. Morasch MD.

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Leon, L., Rodriguez, H., Tawk, R.G. et al. The Prophylactic Use of Inferior Vena Cava Filters in Patients Undergoing High-Risk Spinal Surgery. Ann Vasc Surg 19, 442–447 (2005). https://doi.org/10.1007/s10016-005-0025-1

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  • DOI: https://doi.org/10.1007/s10016-005-0025-1

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