Patient Outcomes Following Placement of a Second Inferior Vena Cava Filter

Abstract

Inferior vena cava (IVC) interruption is being performed with increasing frequency. Indications for this procedure have expanded since the introduction of percutaneous placement techniques. Indications for placement of a second IVC filter are less well defined. It has been reported that a second filter can be placed safely. The purpose of this study was to investigate the intermediate and long-term follow-up of these patients.

Five patients underwent placement of a second IVC filter at one institution from 1992 to 1996. During the same period a total of 439 patients underwent IVC filter placement. The five patients, ranging in age from 46 to 67 years, included three men and two women. The indication for the second filter placement was a confirmed or strongly suspected recurrent pulmonary embolus (PE), with thrombus in and above the previously placed IVC interruption device in all patients. Three of the five patients suffered from poorly controlled malignancies. One patient had an ependymoma of the spinal cord that was completely excised. The fifth patient had a documented hypercoagulable state: factor V resistance to activated protein C. The mean time between placement of the first and second filters was 31 weeks (range: 1-65 weeks). Mean follow-up was 94 weeks (range: 0-252 weeks). One patient died within 24 hours of filter placement from profound hypoxemia from a preexistent PE. No fatal PE occurred in any of the four remaining patients. Two patients in this study, following placement of a second IVC filter, had documented pulmonary emboli that were nonfatal. Two patients died as a result of their underlying malignancies.

While placement of a second IVC interruption device is an infrequently performed procedure, it appears to be efficacious in preventing death from pulmonary emboli in this extremely high-risk group of patients.

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References

1. Rodriguez JL , Lopez JM , Proctor MC , et al: Early placement of prophylactic vena caval filters in injured patients at high risk for pulmonary embolism. J Trauma 40:797-802, 1996.

2. Khansarinia S , Dennis JW , Veldenz HC , et al: Prophylactic Greenfield filter placement in selected highrisk trauma patients. J Vasc Surg 22:231-235, 1995.

3. Cohen JR , Tenenbaum N , Citron M : Greenfield filter as primary therapy for deep venous thrombosis and/or pulmonary embolism in patients with cancer. Surgery 109:12-15, 1991.

4. Calligaro KD , Bergen WS , Haut MJ , et al: Thromboembolic complications in patients with advanced cancer: Anticoagulation versus Greenfield filter placement. Ann Vasc Surg 5:186-189, 1991.

5. Arbogast JD , Blessed WB , Lacoste H , et al: Use of two Greenfield caval filters to prevent recurrent pulmonary embolism in a heparin-allergic gravida. Obstet Gynecol 84:652-654, 1994.

6. Greenfield LJ , Cho KJ , Proctor MC , et al: Late results of suprarenal Greenfield vena cava filter placement. Arch Surg 127:969-973, 1992.

7. Sarasin FP , Eckman MH : Management and prevention of thromboembolic events in patients with cancer-related hypercoagulable states: A risky business. J Gen Intern Med 8:476-486, 1993.

8. Greenfield LJ , Proctor MC : Twenty-year clinical experience with the Greenfield filter. Cardiovasc Surg 3:199-205, 1995.

9. Tardy B , Page Y , Zeni F , et al: Acute thrombosis of a vena cava filter with clot above the filter. Successful treatment with low-dose urokinase. Chest 106:1607-1609, 1994.