Caval Penetration by Inferior Vena Cava Filters: A Systematic Literature Review of Clinical Significance and Management

Circulation. 2015 Sep 8;132(10):944-52. doi: 10.1161/CIRCULATIONAHA.115.016468. Epub 2015 Jul 13.

Abstract

Background: Limited penetration into the caval wall is an important securing mechanism for inferior vena cava (IVC) filters; however, caval penetration can also cause unintentional complications. The aim of this study was to assess the incidence, severity, clinical consequences, and management of filter penetration across a range of commercially available IVC filters.

Methods and results: The MEDLINE database was searched for all studies (1970-2014) related to IVC filters. A total of 88 clinical studies and 112 case reports qualified for analysis; these studies included 9002 patients and 15 types of IVC filters. Overall, penetration was reported in 19% of patients (1699 of 9002), and 19% of those penetrations (322 of 1699) showed evidence of organ/structure involvement. Among patients with penetration, 8% were symptomatic, 45% were asymptomatic, and 47% had unknown symptomatology. The most frequently reported symptom was pain (77%, 108 of 140). Major complications were reported in 83 patients (5%). These complications required interventions including surgical removal of the IVC filter (n=63), endovascular stent placement or embolization (n=11), endovascular retrieval of the permanent filter (n=4), and percutaneous nephrostomy or ureteral stent placement (n=3). Complications led to death in 2 patients. A total of 87% of patients (127 of 146) underwent premature filter retrieval or interventions for underlying symptoms or penetration-related complications.

Conclusions: Caval penetration is a frequent but clinically underrecognized complication of IVC filter placement. Symptomatic patients accounted for nearly 1/10th of all penetrations; most of these cases had organ/structure involvement. Interventions with endovascular retrieval and surgery were required in most of these symptomatic patients.

Keywords: complications; embolic protection devices; vena cava filters; vena cava, inferior.

Publication types

  • Case Reports
  • Review
  • Systematic Review

MeSH terms

  • Device Removal / methods*
  • Device Removal / standards
  • Disease Management*
  • Foreign-Body Migration / diagnosis
  • Foreign-Body Migration / etiology
  • Humans
  • Prosthesis Design / standards
  • Randomized Controlled Trials as Topic / methods
  • Vena Cava Filters / adverse effects*
  • Vena Cava, Inferior / injuries*
  • Vena Cava, Inferior / surgery