Thromboembolic clinical event rates and mortality in patients with and without inferior vena cava filter retrieval in a multicenter study
Rauba J, Jan MF, Allaqaband S, Bajwa T, Nfor T. Thromboembolic clinical event rates and mortality for patients with and without inferior vena cava filter retrieval in a multicenter study. J Vasc Surg Venous Lymphat Disord. 2022;10(4):879-886. doi:10.1016/j.jvsv.2022.01.007
Objective: Despite the widespread use of inferior vena cava filters (IVCF), there are no large controlled trials examining IVCF retrieval rates and clinical events in patients with non-retrieved filters. We hypothesized IVCF retrieval success to decrease as time from placement increased and clinical event rates to be more prevalent in individuals with non-retrieved IVCFs. We evaluated retrieval success as a function of time and compared the rates of venous thromboembolism and mortality between patients who underwent filter retrieval within 12 months vs. patients in whom the filter was not retrieved.
Methods: All patients who underwent IVCF placement between 2011 and 2017 with available follow up data at eight community hospitals were enrolled in this retrospective cohort study. Procedure dates, subsequent deep vein thrombosis (DVT), pulmonary embolism (PE) and mortality dates were collected. Patients were classified as having a non-retrieved filter if their IVCF was never retrieved after 12 months of follow up or longer.
Results: There was successful retrieval in 770 of 1,709 patients who underwent IVCF placement and a significant (p = 0.018) decrease in retrieval success as time from IVCF insertion increased. After a mean (± SD) of 36 months (± 16), the incidence of subsequent DVT was lower in the retrieved than in the non-retrieved group (8.1% vs. 11.9%, p = 0.05), with a hazard ratio (HR) of 0.65 (95% CI 0.42 to 1). Mortality was lower in those with retrieved than non-retrieved filters (8.8% vs. 28.8%, p < 0.001), HR 0.5 (95% CI 0.35 to 0.7). There was no significant difference in the rate of PE.
Conclusions: IVCF non-retrieval was more likely to occur in an older patient population with a higher prevalence of comorbid conditions. Increased rates of subsequent DVT and mortality were observed in patients who did not undergo filter retrieval. The likelihood of successful IVCF retrieval decreased over time.
Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers