IMPROVING THE RETRIEVAL RATE OF INFERIOR VENA CAVA FILTERS: IMPACT IF INFERIOR VENA CAVA FILTER RETRIEVAL IN THE OFFICE ENDOVASCULAR CENTER
OBJECTIVES: Retrievable inferior vena cava filters (IVCFs) are important in the prophylaxis and treatment of pulmonary embolism (PE). Historically, IVCFs remained within the vena cava permanently unless significant complications attributed to the filter arose that necessitated its removal. However, a systematic review of adverse complications attributed to the long-term use of these filters performed by the FDA lead them to formally recommend the retrieval of IVCFs between 25 and 54 days post-insertion to ensure a favorable risk-benefit ratio. The current rates of compliance for this procedure remain low, merely 20% despite the FDA’s endorsement, perhaps due to the perceived complications and unclear recommendations for minimizing risk, as well as the lack of a standardized protocol for following patients post-insertion to increase compliance1. The objectives of this study are: 1.) compare the removal rates between the hospital and office endovascular center (OEC) setting, and 2.) demonstrate the safety and utility of IVCF removal in the OEC setting.
METHODS: In this IRB-approved retrospective study, data was abstracted from the medical records of patients who had an IVCF placed by an OEC physician either in the clinic or OEC (Advanced Vascular Surgery in Kalamazoo, MI) and removed between January 2011 and January 2017. We assessed demographic data, indication for filter, risk factors, retrieval plan status, surgical strategy, complications, duration that the filter was in place, and the outcomes of removal.
RESULTS: IVCF retrieval was attempted in 116/214 patients, while the rest were lost to follow up, died, or the indication changed. Of the patients who had filters placed in the hospital, 76% (n=83) had a removal attempt in the OEC, while 14% had the filter removed in the hospital. All patients who had IVCFs inserted in an OEC had their filters removed in the OEC only (n=18). Of all the filters removed by physicians in this study, 87% (n=101) were removed in an OEC setting. A documented retrieval plan was found in the medical record of 95% of all patients.
All filters were removed via the jugular approach, resulting in 99/101 successful removals (98%)in the OEC. The median time required for the filter removal procedure was 12 minutes. There was no 30-day mortality related to filter removal. Additionally, there were no bleeding complications, despite the fact that patients remained on anti-coagulant therapy during the removal.
In 4% of patients, the filter was removed in less than 3 weeks, 29% of patients between 3 and 6 weeks, 26% of patients between 6 weeks and 3 months, and 40% of patients after 3 months.
CONCLUSION: This study showed comparable removal rates between IVCFs placed in the hospital and an OEC, but it highlighted the integral role an OEC can play in redirecting workflow to an out-patient setting with minimal complications and a streamlined procedure. Availability of an OEC may significantly increase filter removal compliance to meet the latest FDA recommendation. The study also suggests that the incidence of removal of retrievable filters improves with a welldocumented removal plan, as evidenced by this study’s overall removal rate (54%) compared to the national average (20%). This study also demonstrated that retrievable filters can be safely removed in an OEC with extremely high success rates (98%), minimal complications, and without the need to interrupt the patient’s anticoagulation therapy.
1 Minocha J, Idakoji I, Riaz A, Karp J, Gupta R, Chrisman HB, et al. Improving inferior vena cava filter retrieval rates: Impact of a dedicated inferior vena cava filter clinic. J Vasc Interv Radiol 2010;21:1847-51.