The Regained Referral Ground and Clinical Practice of Vena Cava Filter Placement in Vascular Surgery

Abstract

Interventional radiologist rather than vascular surgeons have become the predominant clinicians placing inferior vena cava (IVC) filters since the percutaneous device was introduced more than a decade ago. We conducted a retrospective analysis of 592 patients treated at a single institution between 1987 and 2000 to determine the indications, referral pattern, and clinical outcome of IVC filter placement between the radiologist and surgeon groups. Before 1989 all filters were placed by surgeons in the operating room. The adoption of the percutaneous delivery method by radiologists in 1989 led to a dramatic increase in its practice volume accounting for 99 per cent of all filters placed from 1991 to 1993 (P < 0.001). The development of an endovascular program by the vascular surgeons in 1994 led to a steady increase in its IVC filter practice annually (P < 0.05) and accounted for 42 per cent of all filter placements in 2000. A distinct referral pattern also emerged as 74 per cent of all filter placements by surgeons were referred by surgical services. The proportion of filter placement for strict indications remained constant over time between the two groups (P = 0.86). The complications and survival rates were not significantly different between the two groups (P = 0.24). Percutaneous devices have dramatically increased the clinical volume of IVC filter placement by interventional radiologists. Vascular surgeons with endovascular interest are well suited to perform the procedure and can regain referral ground of IVC filter placement.