Inferior Vena Cava Filter Placement in Late-Stage Cancer

Abstract

Inferior vena cava (IVC) filters are increasingly used in patients with advanced-stage cancer for prophylaxis of pulmonary embolus. We evaluated the survival benefit of placing IVC filters in patients with late-stage malignancy and assessed their effectiveness in preventing pulmonary embolism. Between 1998 and 2003, 5,970 patients were treated with a primary diagnosis of malignancy at a tertiary care facility. Retrospective analysis identified 55 consecutive patients with stage III or IV malignant disease and venous thromboembolism (VTE) who received IVC filters. Retrospective review of electronic hospital charts identified subsequent pulmonary emboli, procedure-related complications, and survival. In a case control study, 16 patients with VTE but without IVC filter were matched for age, sex, type of malignancy, and stage of disease. IVC filter placement effectively prevented computed tomography (CT) scan or ventilation/perfusion ratio (V/Q) scan-proven pulmonary embolus in 52/55 (94.5%) patients. Complications developed in 4/55 or 7.3% of patients; 13/55 (23.6%) patients with late-stage cancer survived less than 30 days following placement of the filter. Another 23.6% of this group survived longer than 1 year. Ambulatory status differed significantly (p=0.01) between these 2 subgroups. In the case control study, IVC filter placement conferred no survival benefit compared to the control group. One recurrent pulmonary embolism was observed in both the filter group and the control group. No deaths due to thromboembolic complications were observed in either group. In late-stage cancer, patient survival is limited primarily by the malignant process. While IVC filter placement is effective in preventing pulmonary emboli, there may be limited survival benefit in this particular patient population. However, there exists a subset of this population whose functional status predicts longer survival times after filter placement.

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