TY - JOUR
T1 - Practice patterns and outcomes of retrievable vena cava filters in trauma patients
T2 - An AAST multicenter study
AU - Karmy-Jones, Riyad
AU - Jurkovich, Gregory J.
AU - Velmahos, George C.
AU - Burdick, Thomas
AU - Spaniolas, Konstantinos
AU - Todd, Samuel R.
AU - McNally, Michael
AU - Jacoby, Robert C.
AU - Link, Daniel
AU - Janczyk, Randy J.
AU - Ivascu, Felicia A.
AU - McCann, Michael
AU - Obeid, Farouck
AU - Hoff, William S.
AU - McQuay, Nathaniel
AU - Tieu, Brandon H.
AU - Schreiber, Martin A.
AU - Nirula, Ram
AU - Brasel, Karen
AU - Dunn, Julie A.
AU - Gambrell, Debbie
AU - Huckfeldt, Roger
AU - Harper, Jayna
AU - Schaffer, Kathryn B.
AU - Tominaga, Gail T.
AU - Vinces, Fausto Y.
AU - Sperling, David
AU - Hoyt, David
AU - Coimbra, Raul
AU - Rosengart, Mathew R.
AU - Forsythe, Raquel
AU - Cothren, Clay
AU - Moore, Ernest E.
AU - Haut, Elliott R.
AU - Hayanga, Awori J.
AU - Hird, Linda
AU - White, Christopher
AU - Grossman, Jodi
AU - Nagy, Kimberly
AU - Livaudais, West
AU - Wood, Rhonda
AU - Zengerink, Imme
AU - Kortbeek, John B.
PY - 2007/1
Y1 - 2007/1
N2 - BACKGROUND: The purpose of this study is to describe practice patterns and outcomes of posttraumatic retrievable inferior vena caval filters (R-IVCF). METHODS: A retrospective review of R-IVCFs placed during 2004 at 21 participating centers with follow up to July 1, 2005 was performed. Primary outcomes included major complications (migration, pulmonary embolism [PE], and symptomatic caval occlusion) and reasons for failure to retrieve. RESULTS: Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% for prophylactic indications and 79% were placed by interventional radiology. Excluding 33 deaths, 152 were Gunter-Tulip (G-T), 224 Recovery (R), and 37 Optease (Opt). Placement occurred 6 ± 8 days after admission and retrieval at 50 ± 61 days. Follow up after discharge (5.7 ± 4.3 months) was reported in 51%. Only 22% of R-IVCFs were retrieved. Of 115 patients in whom retrieval was attempted, retrieval failed as a result of technical issues in 15 patients (10% of G-T, 14% of R, 27% of Opt) and because of significant residual thrombus within the filter in 10 patients (6% of G-T, 4% of R, 46% Opt). The primary reason R-IVCFs were not removed was because of loss to follow up (31%), which was sixfold higher (6% to 44%, p = 0.001) when the service placing the R-IVCF was not directly responsible for follow up. Complications did not correlate with mechanism, injury severity, service placing the R-IVCF, trauma volume, use of anticoagulation, age, or sex. Three cases of migration were recorded (all among R, 1.3%), two breakthrough PE (G-T 0.6% and R 0.4%) and six symptomatic caval occlusions (G-T 0, R 1%, Opt 11%) (p < 0.05 Opt versus both G-T and R). CONCLUSION: Most R-IVCFs are not retrieved. The service placing the R-IVCF should be responsible for follow up. The Optease was associated with the greatest incidence of residual thrombus and symptomatic caval occlusion. The practice patterns of R-IVCF placement and retrieval should be re-examined.
AB - BACKGROUND: The purpose of this study is to describe practice patterns and outcomes of posttraumatic retrievable inferior vena caval filters (R-IVCF). METHODS: A retrospective review of R-IVCFs placed during 2004 at 21 participating centers with follow up to July 1, 2005 was performed. Primary outcomes included major complications (migration, pulmonary embolism [PE], and symptomatic caval occlusion) and reasons for failure to retrieve. RESULTS: Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% for prophylactic indications and 79% were placed by interventional radiology. Excluding 33 deaths, 152 were Gunter-Tulip (G-T), 224 Recovery (R), and 37 Optease (Opt). Placement occurred 6 ± 8 days after admission and retrieval at 50 ± 61 days. Follow up after discharge (5.7 ± 4.3 months) was reported in 51%. Only 22% of R-IVCFs were retrieved. Of 115 patients in whom retrieval was attempted, retrieval failed as a result of technical issues in 15 patients (10% of G-T, 14% of R, 27% of Opt) and because of significant residual thrombus within the filter in 10 patients (6% of G-T, 4% of R, 46% Opt). The primary reason R-IVCFs were not removed was because of loss to follow up (31%), which was sixfold higher (6% to 44%, p = 0.001) when the service placing the R-IVCF was not directly responsible for follow up. Complications did not correlate with mechanism, injury severity, service placing the R-IVCF, trauma volume, use of anticoagulation, age, or sex. Three cases of migration were recorded (all among R, 1.3%), two breakthrough PE (G-T 0.6% and R 0.4%) and six symptomatic caval occlusions (G-T 0, R 1%, Opt 11%) (p < 0.05 Opt versus both G-T and R). CONCLUSION: Most R-IVCFs are not retrieved. The service placing the R-IVCF should be responsible for follow up. The Optease was associated with the greatest incidence of residual thrombus and symptomatic caval occlusion. The practice patterns of R-IVCF placement and retrieval should be re-examined.
UR - http://www.scopus.com/inward/record.url?scp=33846226087&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e31802dd72a
DO - 10.1097/TA.0b013e31802dd72a
M3 - Article
C2 - 17215729
AN - SCOPUS:33846226087
SN - 0022-5282
VL - 62
SP - 17
EP - 24
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 1
ER -