1. Columbia University College of Physicians and Surgeons
Classes of Filters and Complications
John H. Rundback, MD, FAHA, FSVMB, FSIR The Interventional Institute at Holy Name Hospital
Columbia University College of Physicians and Surgeons

2. John H. Rundback, MD DISCLOSURES Consulting Fees Honoraria
ev3, Inc., Medtronic CardioVascular, Inc., Boston Scientific Corporation
Honoraria
Medtronic CardioVascular, Inc., Boston Scientific Corporation
Grants/Contracted Research
DSMC for VIVA (Abbott Trial), ev3, Inc., Abbott Vascular, C.R. Bard, Inc., Atrium Medical Corporation, W. L. Gore & Associates, Inc., Cordis, a Johnson & Johnson company, Terumo Medical Corporation

3. Classes of Filters Permanent Temporary Filter attached to tether
Must be removed
Optional – Retrievable
Self-affixing to IVC wall
Permanence is optional
Optional – Convertible
Self –affixing to IVC wall
Device is permanent, but filtration is optional

4. NON-PERMANENT

5. Option Filter (Rex Medical)
SafeFlo Filter
(Rafael Medical)
Crux Filter (Crux Biomedical)
ALN Filter (ALN Implants)

6. IVC Filter Complications
Death
Caval Thrombosis
Breakthrough PE
Deep Venous Thrombosis
Post-phlebitic syndrome
Migration
Embolization
Caval Penetration
Caval Injury with retrieval

7. SIR QI Guidelines (JVIR 2003)

8. Cardiac Migration
Essentially no difference across permanent filter types
Chest Sep;136:877-87

9. Fracture and Cardiac Migration
JVIR 2008 July

10. Caval Thrombosis and DVT

18. Decousus Study 400 patients with proximal DVT
Randomized to anticoagulation vs. filter and anticoagulation
Outcome measures: death, recurrent VTE, major bleeding
Analysis at day 12 and 2 years
NEJM February 2008

19. 2 year f/u DVT: 20% with filter, 12% without (p<0.05)
Recurrent PE, death: no difference

20. PREPIC 8-Year Update Recurrent DVT
Filter: 57 (34.1%)
50% filter + DVT had filter thrombosis
No filter: 41 (27.3%)
Symptomatic PE
Filter: 9 (6.2%), 2 fatal
No filter: 24 (15.1%) 5 fatal
Post–thrombotic syndrome: 56% in both groups
Ulcers 5 filter, 15 non-filter
No survival benefit with filter
P=0.042
P=0.008
Circulation 2005;112:416

21. 11 articles, 1552 patients, 4.5 yr mean f/u
JVIR July 2008
11 articles, 1552 patients, 4.5 yr mean f/u
One study reported no difference in PTS according to whether anticoagulation was initiated in addition to filter placement.
No study reported rates of PTS according to use of elastic compression stockings after filter placement.
Pooled Weighted Frequency of PTS
Indication
# pts
Edema
Trophic ∆‘s or ulcer
Mean f/u
1o Prevention
302
20.2%
8.3% / 2%
2.1 y
2o Prevention
1103
51.2%
13.5% / 3.8%
5.6 y

22. JVIR Mar 2008
Recovery and Tulip Filters
15.5% of retrievable filters underwent attempted removal  70% successfully retrieved

23. Failed Retrieval

24. Conclusions
There is an increasing trend towards the placement of optional IVC filters although most are not removed.
No substantial differences in major complications exist across filter classes or types.
Major risk is recurrent VTE which occurs in approximately 20% of cases.