A quality improvement project to improve inferior vena cava filter retrieval

Todd E Simon; Patrick F Walker; Leo J Daab; Joseph M White; Paul W White

doi:10.1016/j.jvsv.2016.09.004

A quality improvement project to improve inferior vena cava filter retrieval

J Vasc Surg Venous Lymphat Disord. 2017 Jan;5(1):42-46. doi: 10.1016/j.jvsv.2016.09.004. Epub 2016 Nov 9.

Authors

Todd E Simon¹, Patrick F Walker¹, Leo J Daab², Joseph M White¹, Paul W White³

Affiliations

¹ Vascular Surgery Service, Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md.
² Vascular Surgery Service, Department of Surgery, Madigan Army Medical Center, Tacoma, Wash.
³ Vascular Surgery Service, Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Md. Electronic address: paul.w.white4.mil@mail.mil.

PMID: 27987608
DOI: 10.1016/j.jvsv.2016.09.004

Abstract

Objective: Poor retrieval rates for retrievable inferior vena cava filters (R-IVCFs) have been reported throughout the literature, with poor follow-up a common cause. In 2009, we reported a retrieval rate of 18% despite an initial follow-up rate of 85%. Use of a registry has been shown to improve retrieval rates. As a quality improvement project, in May 2012, the vascular surgery fellowship implemented a reiterative registry to track R-IVCFs placed at Walter Reed National Military Medical Center to improve retrieval rates. We report the results in 125 patients after 38 months.

Methods: Patients receiving an R-IVCF were entered into a registry. All patients were reviewed monthly using an electronic health record. When there was no longer an indication for the R-IVCF, the patient was scheduled for an outpatient appointment with a vascular surgeon followed by retrieval. Rates of retrieval, technical success, dwell time, indication, complications, and demographics were collected.

Results: There were 125 R-IVCFs placed between May 2012 and June 2015; 52 filters were placed for therapeutic and 73 for prophylactic indications. Our follow-up rate improved to 94%. A total of 79 filters were retrieved (63% absolute retrieval rate). Excluding patients who died before retrieval and patients with a permanent indication, 77% of filters were retrieved. The average dwell time was 101.5 days (7-460 days), and 63% of successful R-IVCF retrievals were within 3 months of placement. Technical success for retrieval was 92%. There were two major complications from retrievals (1.5% of retrievals).

Conclusions: The creation of an R-IVCF registry promoted ongoing follow-up with patients. In our earlier experience, retrieval rates were poor despite a high follow-up rate. The use of a reiterative registry improved our retrieval rate by 45% and increased our follow-up rate to 94%. These results emphasize the importance of repetitive follow-up for R-IVCFs. Despite a follow-up rate >90%, around a third of R-IVCFs were not retrieved.

Published by Elsevier Inc.

MeSH terms

Adult
Aged
Device Removal / methods
Device Removal / standards*
Device Removal / statistics & numerical data
Female
Humans
Long-Term Care / methods
Male
Maryland
Middle Aged
Prosthesis Failure
Quality Improvement / organization & administration*
Registries
Vena Cava Filters*