Abstract
Objectives
The purpose of this study was to evaluate the necessity of and recommend indications for inferior vena cava (IVC) filter implantation during percutaneous endovenous intervention (PEVI) for deep venous thrombosis (DVT).
Background
PEVI has emerged as a powerful tool in the management of acute proximal DVT. Instrumentation of extensive fresh thrombus is potentially associated with iatrogenic pulmonary embolism (PE). The true frequency of this complication has not been studied in a randomized fashion. We evaluated IVC filter implantation during PEVI for DVT.
Methods
A total of 141 patients with symptomatic proximal DVT undergoing PEVI for symptomatic DVT were randomized to receive an IVC filter (70 patients) or no filter (71 patients; control group). The anticoagulation and PEVI regimen were similar between the two groups. Patients with development of symptoms suggestive of PE underwent objective testing for PE.
Results
PE developed in 1 of the 14 symptomatic patients in the filter group and 8 of the 22 patients in the control group (P = 0.048). There was no mortality in any group. Three patients (4.2%) in the control group had transient hemodynamic instability necessitating resuscitory efforts. Predictors of iatrogenic PE were found to be PE at admission; involvement of two or more adjacent venous segments with acute thrombus; inflammatory form of DVT (severe erythema, edema, pain, and induration); and vein diameter of ≥7 mm with preserved architecture.
Conclusions
IVC filter implantation during PEVI reduces the risk of iatrogenic PE by eightfold without a mortality benefit. A selective approach may be exercised in filter implantation during PEVI.
Similar content being viewed by others
References
Pollack C (2011) Advanced management of acute ileofemoral deep venous thrombosis: emergency department and beyond. Ann Emerg Med 57:590–599
Enden T, Klow NE, Sandvik L et al (2009) Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep venous thrombosis: results of an open randomized, controlled trial reporting on short-term patency. J Thromb Haemost 7:1268–1275
Sharifi M, Mehdipour M, Bay C et al (2010) Endovenous therapy for deep venous thrombosis: the TORPEDO trial. Catheter Cardiovasc Interv 76:316–325
Kolbel T, Alhadad A, Acosta S et al (2008) Thrombus embolization into IVC filters during catheter-directed thrombolysis for proximal deep venous thrombosis. J Endovasc Ther 15:605–613
Thery C, Bauchart JJ, Lesenne M et al (1992) Predictive factors of effectiveness of streptokinase in deep venous thrombosis. Am J Cardiol 69:117–122
Protack C, Bakken A, Patel N et al (2007) Long-term outcomes of catheter directed thrombolysis for lower extremity deep venous thrombosis without prophylactic inferior vena cava filter placement. J Vasc Surg 45:992–997
Decousus H, Leizorovicz A, Parent F et al (1998) 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 338:409–415
Streiff M (2000) Vena caval filters: a comprehensive review. Blood 95:3669–3677
Kinney T (2003) Update on inferior vena cava filters. J Vasc Interv Radiol 14:425–440
Yamagami T, Yoshimatsu R, Matsumoto T, Nishimura T (2008) Prophylactic implantation of inferior vena cava filter during endovascular therapies for deep venous thrombosis of the lower extremity: Is it necessary? Acta Radiol 49:391–397
Mewissen MW, Seabrook GR, Meissner MH et al (1999) Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology 211:39–49
PREPIC Study Group (2005) 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 112:416–422
Conflict of interest
M.S. is a consultant to Covidien. The other authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sharifi, M., Bay, C., Skrocki, L. et al. Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial. Cardiovasc Intervent Radiol 35, 1408–1413 (2012). https://doi.org/10.1007/s00270-012-0342-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-012-0342-z