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Background:
The role for inferior vena cava (IVC) filters in the oncology population is poorly defined.
Objectives:
Our primary endpoint was to determine the rate of filter placement in cancer patients without an absolute contraindication to anticoagulation and the rate of recurrent VTE after filter placement in both retrievable and permanent fi...
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A 72-year-old male underwent placement of a Gunther-tulip vena cava filter to prevent development of a pulmonary embolism. One month later, when we tried to retrieve the Gunther-tulip vena cava filter via a transjugular approach, the filter detached from the snare and became free in the outer sheath. The Gunther-tulip vena cava filter did not reope...
Objectives
Inferior vena cava (IVC) filters are commonly used. However, there is no clear consensus on the benefits and risks from randomized, controlled trials (RCTs). Therefore, we aimed to investigate it.
Methods
PubMed and Cochrane libraries were searched from inception to 31st OCT 2019 to identify RCTs to perform meta-analyses. The primary ou...
Citations
... Survival after filter placement was short and varied between the filter groups. The median time from filter implantation to death was 3.2 months in the permanent filter group and 8.9 months in the retrievable filter group [17]. Altogether, these results suggest that the benefits of IVC filter placement in patients with end-stage cancer are not evident. ...
... However, in the population of cancer patients, the filter removal rate was only 40%, despite using the above-mentioned approach [22]. Specifically, in the study conducted by Shaikh et al., only 40% of the 179 retrievable filters in oncology patients were retrieved [17]. This is in line with our observations, where filter removal was attempted in 21% of the oncology patients and as many as 71% of the control patients. ...
... Interestingly, this complication was similar in the cancer and non-cancer groups (23.1% of filters removed in the oncology group vs. 20.5% of filters removed in the non-oncology group, p = 1000). This is higher than the rates found in the study by Shaikh et al., where clotted filters occurred in 6.9% (5/72) of filters removed [17]. However, in our study, we did not record a single case of caval thrombosis. ...
Simple Summary
In the oncology population, the risk of venous thromboembolism is significantly increased. Therefore, advanced therapeutic options, such as inferior vena cava (IVC) filters, can be an important part of treatment. Our observational, retrospective study compared the outcomes of IVC filter placement in the oncology population consisting of 62 patients and a non-oncology control group of 117 patients in the years 2012–2023. In both groups, there were no complications during IVC filter implantation procedures. In the oncology group, there was no recurrence of pulmonary embolism or deep vein thrombosis after filter implantation. There was no significant difference in other clinical outcomes between the two subgroups. Our study emphasized that the IVC filter is an effective method when standard anticoagulation treatment is not available for oncology patients. The use of inferior vena cava filters in this challenging population is also as safe as in non-oncology patients.
Abstract
The risk of venous thromboembolism (VTE) in the oncology population is significantly higher than in non-cancer patients. Inferior vena cava (IVC) filters may, therefore, be an important part of VTE treatment. In this study, we address the outcomes of placing IVC filters in the oncology population. This single-centre, observational, retrospective study included 62 patients with active malignancy and acute VTE who underwent an IVC filter implantation due to contraindications to anticoagulation during the period 2012–2023. The control group consisted of 117 trauma patients. In both groups, an urgent surgical procedure requiring temporary cessation of anticoagulation was the most noted reason for IVC filter placement—76% in the oncology group vs. 100% in the non-oncology group (p < 0.001). No complications were reported during the IVC filter implantation procedures. There was no recurrence of pulmonary embolism or deep venous thrombosis in the oncology group after filter implantation. The rate of successful filter explantation, median time to retrieval, and abnormal findings during retrieval were not significantly different between both subgroups (64.3% vs. 76.5%, p = 0.334; 77 days vs. 84 days, p = 0.764; 61.5% vs. 54.2%, p = 0.672; respectively). The study showed that IVC filter placement is a safe and effective method of preventing PE in cancer patients with contraindications to anticoagulation. The complication rate following IVC filter implantation in cancer patients is low and similar to that in non-oncology patients.
... These researchers also found that 20% of the patients with retrievable filters and 24% with permanent filters had recurrent VTEs. The median survival in this study was also consistent with previous literature, with 8.9 months in patients with the retrievable filter group and 3.2 months in the permanent filter group [44]. In addition to the lack of benefits, there are indicators of possible harm. ...
... The cost of a permanent filter device was USD 4695 and USD 13,289, totaling USD 17,984. The authors' institution found that over the approximately five-year study period, the total cost of retrievable filters, including their placement and retrieval, which only occurred in 40% of patients, was USD 2,883,389, while the total cost of permanent filters and their placement was USD 3,722,688 for a combined total of over USD 6.6 million for 386 patients in the study [44]. This adds to the substantial financial burden cancer patients face in their final years or months, especially when considering the lack of clear benefits [47]. ...
Background: Inferior vena cava (IVC) filters serve as a vital intervention when systemic anticoagulation proves ineffective or contraindicated, particularly in the context of cancer patients. This study aimed to provide real-world insights into the outcomes of cancer patients following IVC filter placement. Patients and methods: Cancer patients with IVC filters were retrospectively reviewed. The indications and survival outcomes following IVC filter insertion have been reported. Results: A total of 176 cancer patients with IVC filters were included in the study. The median patient age was 56 years (range: 18–88 years). Solid tumors were the most common primary cancers (n = 125, 71.0%), and the majority (n = 99, 79.2%) had the advanced-stage disease at the time of IVC insertion. The filters were inserted because of contraindications to anticoagulation (n = 99, 56.3%) or the failure of anticoagulation (n = 56, 31.8%). The median survival (range) following filter placement was only 2 (1.45–2.55) months for patients with advanced-stage solid tumors, 5 (0.62–9.38) months for patients with brain tumors, and 44 (8.59–79.41) months for those with early-stage solid tumors, p < 0.001. Conclusions: Our findings suggest that IVC filter placement offers limited benefits to patients with advanced-stage disease. The underlying tumor, stage, and life expectancy are crucial factors in the decision-making process before IVC filter insertion.
Intravascular tumor extension is an uncommon complication of solid malignancies that, when present in the inferior vena cava (IVC), can result in fatal pulmonary tumor embolism. Currently, neoadjuvant chemotherapy and surgery are the mainstays of treatment; however, there are no consensus guidelines for management. We describe three cases of pediatric solid malignancies with associated IVC extension and pulmonary tumor embolism. We hypothesize that there is scope for IVC filter placement in such cases to mitigate the risk of fatal pulmonary tumor embolism.
Inferior vena cava (IVC) filters have been used since the 1960s to treat patients with acute risk of pulmonary embolism (PE) to prevent migration of thrombus by trapping it within the filter. Traditional usage has been in patients with contraindication to anticoagulation that carry a significant mortality risk. In this systematic review, we sought to evaluate complications associated with placement of inferior vena cava filters based on published data from the past 20 years. A search was performed on October 6th, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews, using three databases (ProQuest, PubMed and ScienceDirect) for articles published between the dates of February 1, 2002 and October 1, 2022. Results were filtered to include full-text, clinical studies, and randomized trials written in English pertaining to keywords "IVC filter AND complications", "Inferior Vena Cava Filter AND complications", "IVC filter AND thrombosis" and "Inferior Vena Cava Filter AND thrombosis". Articles identified by the three databases were pooled and further screened for relevance based on inclusion and exclusion criteria. Initial search results yielded 33,265 hits from all three databases combined. Screening criteria were applied, with 7721 results remaining. After further manual screening, including removal of duplicate hits, a total of 117 articles were selected for review. While there are no consensus guidelines for best practice, there is compelling evidence that IVC filters can provide significant protection against PE with minimal complications if the treatment window is appropriate. Increase in the variety of filter models has led to broader availability, but skepticism remains about their efficacy and safety, with ongoing controversy surrounding appropriate indications. Further research is needed to establish clear guidelines on appropriate indications for IVC placement and to determine time course of complications versus benefits for indwelling filters.
Background:
Standard treatment for venous thromboembolism is anticoagulation; vena cava filter placement is an alternative in special situations. We aimed to evaluate the outcomes in cancer patients undergoing filter placement in a cancer center during a 10-year-period and assess which preoperatory variables were associated with poorer survival.
Methods:
Retrospective uni-center analysis over a 10-year period was carried out in cancer patients who had undergone placement of vena cava filter. Early deaths were those that occurred less than 30 days after the filter placement, or that occurred during the same hospital stay of the placement.
Results:
250 patients were analyzed. 51.6% were female; 77.2% had proximal lower limb DVT; 34.8% had contraindications to anticoagulation; 32.8% presented bleeding after the onset of anticoagulation and 18.4% had the filter implanted because they were going to undergo surgery, and could not be anticoagulated immediately after. 51.2% of the filters were removable. However, only 2 had the filter removed. 59.2% had metastatic disease at the time of filter placement. 31.2% fulfilled criteria for "early" death. Of those, 34 patients were put in palliative care after filter insertion (median=13.5 days). Body mass index> 18kg/m2, absence of metastatic disease and filter placement during the same anesthesia of another surgery (especially if elective and curative) were associated with a higher chance of survival.
Conclusion:
Multidisciplinary evaluation (and possibly consideration for palliation) should take place before the decision to insert a vena cava filter in severe oncological cases depending on overall status. Patients with a greater chance of survival at a 3 or 5 years interval seem to be those whose filters were placed in the peri-operative context of other surgeries (specially elective and curative), who were not undernourished and whose disease was not metastatic at that time. For patients who survived, an active investigation protocol for filter removal should be implemented.
