The use of retrievable inferior vena cava filters in severely injured military trauma patients

J Vasc Surg. 2009 Feb;49(2):410-6; discussion 416. doi: 10.1016/j.jvs.2008.09.004. Epub 2008 Nov 28.


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.

MeSH terms

  • Adult
  • Afghan Campaign 2001-
  • Blood Vessels / injuries*
  • Device Removal*
  • Female
  • Follow-Up Studies
  • Humans
  • Iraq War, 2003-2011
  • Male
  • Military Personnel*
  • Phlebography
  • Registries
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • United States
  • Vascular Surgical Procedures / adverse effects
  • Vascular Surgical Procedures / instrumentation*
  • Vena Cava Filters*
  • Vena Cava, Inferior / diagnostic imaging
  • Vena Cava, Inferior / surgery*
  • Wounds and Injuries / diagnostic imaging
  • Wounds and Injuries / surgery*
  • Young Adult