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The role of retrievable inferior vena cava filters in cancer patients: a comprehensive single center experience in 646 patients
SCIENTIFIC SESSIONS: TUESDAY
Scientific Session 23 IVC Filters II Tuesday, April 5, 2016 3:00 PM – 4:30 PM Room: 114/115
Conclusions: Patients with metastatic disease have a significantly lower rIVCF retrieval rate and are nearly twice as likely to have a rIVCF remain permanent when compared to patients without metastatic disease. Given the well-documented increased rate of device-related complications associated with rIVCF, patients with metastatic disease may be best served by permanent devices.
3:09 PM
Abstract No. 218
Inferior vena cava filter retrieval: an 18 year single center experience 3:00 PM
Abstract No. 217
The role of retrievable inferior vena cava filters in cancer patients: a comprehensive single center experience in 646 patients M. Pandhi1, K. Desai1, S. Mouli2, J. Gehl3, R. Salem4, J. Karp5, R. Ryu6, R. Lewandowski1; 1Northwestern University, Chicago, IL; 2Northwestern University Feinberg School of Medicine, Chicago, IL; 3Mequon, WI; 4 Northwestern Memorial Hospital, Chicago, IL; 5Chicago, IL; 6University of Colorado Denver, Aurora, CO
Purpose: Retrieval of the Inferior Vena Cava (IVC) filters has become a standard practice to reduce the long term complications of continued IVC filtration. The purpose of this study was to review outcomes associated with retrieval of IVC filters at a single center. Materials: This IRB approved retrospective study included all IVC filter removal attempts between July 1997 and July 2015 at our tertiary care hospital. A query of Radiology Information System and electronic medical record provided the procedure data. For outcomes, the inpatient administrative database was queried to identify patients with an IVC filter removed during an inpatient encounter. Acute VTE events, including PE, were defined by AHRQ PSI-12 criteria. Analyses were conducted using IBM SPSS Statistics 20. Results: 398 patients had a total of 408 IVC filter retrieval attempts during the study period. Successful initiation of anticoagulation (53.2%), no further indication for PE prophylaxis (31.9%) and filter related complication (4.2%) were the primary indications for retrieval. Most common preprocedure imaging study was Duplex ultrasonography (58.8%). Overall success rate for retrieval was 88.5%. When pre-retrieval imaging showed the case as an anticipated simple retrieval (75%), chances of success were very high (97.7%) vs an anticipated complex retrieval where success rates were low (64.2%). The most commonly reported reason for retrieval failure was tilt (21.3%). Average filter life in-vivo was 182 days. 143 patients had filter retrieval attempts as inpatients. 6 (4.2%) patients died during same hospital visit. 12/137 (8.8%) patients whose filter was retrieved were readmitted within 30 days, and 6 (50%) of those patients had a VTE diagnosed during their readmission, among whom 2 had a PE. Conclusions: Despite high rates of safe and effective filter retrieval, 8.8% cases with successful filter removal were readmitted within 30 days; half of whom developed an acute VTE, indicating that some IVC filters may be removed prematurely. Additional work is needed to inform the optimal time for retrieval to minimize the incidence of VTE among patients, whereby maximizing the benefit of IVC filters.
TUESDAY: Scientific Sessions
Purpose: Cancer induces a hypercoagulable state rendering patients susceptible to venous thromboembolism, with many patients requiring placement of an inferior vena cava (IVC) filter. Limited data exist regarding IVC filter use in this subset of patients; furthermore, prior studies have demonstrated that retrievable IVC filters (rIVCF) are subject to greater device related complications than permanent IVC filters (pIVCF). We hypothesize that rIVCF have a limited role in cancer patients with metastatic disease due to low retrieval rates; thereby unnecessarily exposing patients to increased device-related complications. Materials: From January 2009 to June 2015, 646 consecutive cancer patients presenting for IVC filter placement were identified from a prospectively collected database. Clinical history, indication for IVC filtration, type of filter, and IVC filter disposition (“kept permanent,” “retrieved,” or “failed retrieval”) were collected. Fisher’s exact test and odds ratios (OR) were calculated; statistical significance accepted at po0.05. Results: 51% (n¼330) of patients received a rIVCF; 29% (n¼186) of patients had metastases at the time of filter placement. Of the patients with metastatic disease, 72% received pIVCF (n¼133) while 28% received rIVCF (n¼53). In patients with metastases, 34% (n¼18) had their rIVCF retrieved, whereas 51% (n¼140) of patients without metastases underwent successful filter retrieval (p¼0.04). Patients with metastatic disease were nearly twice as likely to have a retrievable filter remain permanent than those without metastatic disease (OR 1.99, 95% CI 1.07-3.68, p¼0.03).
M. Umair1, B. Lau1, N. Readal1, B. Holly2, C. Weiss1; 1 Johns Hopkins Hospital, Baltimore, MD; 2Johns Hopkins Hospital, Elkridge, MD
Scientific Session 23 IVC Filters II Tuesday, April 5, 2016 3:00 PM – 4:30 PM Room: 114/115
Conclusions: Patients with metastatic disease have a significantly lower rIVCF retrieval rate and are nearly twice as likely to have a rIVCF remain permanent when compared to patients without metastatic disease. Given the well-documented increased rate of device-related complications associated with rIVCF, patients with metastatic disease may be best served by permanent devices.
3:09 PM
Abstract No. 218
Inferior vena cava filter retrieval: an 18 year single center experience 3:00 PM
Abstract No. 217
The role of retrievable inferior vena cava filters in cancer patients: a comprehensive single center experience in 646 patients M. Pandhi1, K. Desai1, S. Mouli2, J. Gehl3, R. Salem4, J. Karp5, R. Ryu6, R. Lewandowski1; 1Northwestern University, Chicago, IL; 2Northwestern University Feinberg School of Medicine, Chicago, IL; 3Mequon, WI; 4 Northwestern Memorial Hospital, Chicago, IL; 5Chicago, IL; 6University of Colorado Denver, Aurora, CO
Purpose: Retrieval of the Inferior Vena Cava (IVC) filters has become a standard practice to reduce the long term complications of continued IVC filtration. The purpose of this study was to review outcomes associated with retrieval of IVC filters at a single center. Materials: This IRB approved retrospective study included all IVC filter removal attempts between July 1997 and July 2015 at our tertiary care hospital. A query of Radiology Information System and electronic medical record provided the procedure data. For outcomes, the inpatient administrative database was queried to identify patients with an IVC filter removed during an inpatient encounter. Acute VTE events, including PE, were defined by AHRQ PSI-12 criteria. Analyses were conducted using IBM SPSS Statistics 20. Results: 398 patients had a total of 408 IVC filter retrieval attempts during the study period. Successful initiation of anticoagulation (53.2%), no further indication for PE prophylaxis (31.9%) and filter related complication (4.2%) were the primary indications for retrieval. Most common preprocedure imaging study was Duplex ultrasonography (58.8%). Overall success rate for retrieval was 88.5%. When pre-retrieval imaging showed the case as an anticipated simple retrieval (75%), chances of success were very high (97.7%) vs an anticipated complex retrieval where success rates were low (64.2%). The most commonly reported reason for retrieval failure was tilt (21.3%). Average filter life in-vivo was 182 days. 143 patients had filter retrieval attempts as inpatients. 6 (4.2%) patients died during same hospital visit. 12/137 (8.8%) patients whose filter was retrieved were readmitted within 30 days, and 6 (50%) of those patients had a VTE diagnosed during their readmission, among whom 2 had a PE. Conclusions: Despite high rates of safe and effective filter retrieval, 8.8% cases with successful filter removal were readmitted within 30 days; half of whom developed an acute VTE, indicating that some IVC filters may be removed prematurely. Additional work is needed to inform the optimal time for retrieval to minimize the incidence of VTE among patients, whereby maximizing the benefit of IVC filters.
TUESDAY: Scientific Sessions
Purpose: Cancer induces a hypercoagulable state rendering patients susceptible to venous thromboembolism, with many patients requiring placement of an inferior vena cava (IVC) filter. Limited data exist regarding IVC filter use in this subset of patients; furthermore, prior studies have demonstrated that retrievable IVC filters (rIVCF) are subject to greater device related complications than permanent IVC filters (pIVCF). We hypothesize that rIVCF have a limited role in cancer patients with metastatic disease due to low retrieval rates; thereby unnecessarily exposing patients to increased device-related complications. Materials: From January 2009 to June 2015, 646 consecutive cancer patients presenting for IVC filter placement were identified from a prospectively collected database. Clinical history, indication for IVC filtration, type of filter, and IVC filter disposition (“kept permanent,” “retrieved,” or “failed retrieval”) were collected. Fisher’s exact test and odds ratios (OR) were calculated; statistical significance accepted at po0.05. Results: 51% (n¼330) of patients received a rIVCF; 29% (n¼186) of patients had metastases at the time of filter placement. Of the patients with metastatic disease, 72% received pIVCF (n¼133) while 28% received rIVCF (n¼53). In patients with metastases, 34% (n¼18) had their rIVCF retrieved, whereas 51% (n¼140) of patients without metastases underwent successful filter retrieval (p¼0.04). Patients with metastatic disease were nearly twice as likely to have a retrievable filter remain permanent than those without metastatic disease (OR 1.99, 95% CI 1.07-3.68, p¼0.03).
M. Umair1, B. Lau1, N. Readal1, B. Holly2, C. Weiss1; 1 Johns Hopkins Hospital, Baltimore, MD; 2Johns Hopkins Hospital, Elkridge, MD