Inferior Vena Cava Filter Retrieval: a Review of Seven Yearsʼ Experience at a Regional Hospital
WH Chong, KL Siu, WS Wan, KY Chan, CB Tan
Hong Kong J Radiol 2017;20:121-5
DOI: 10.12809/hkjr1715388
Objective: To identify predictors of successful retrieval of inferior vena cava (IVC) filter by comparing patients with and without a retrieval request.
Methods: Medical records of consecutive patients who underwent insertion / retrieval of the IVC Cordis OptEase retrievable filter via the femoral route between January 2008 and December 2014 at a regional hospital were reviewed.
Results: 64 male and 93 female patients aged 15 to 94 (mean, 66.7) years were divided into those with (n = 37) or without (n = 120) a retrieval request. Compared with patients without a retrieval request, those with such a request were more likely to be aged <70 years (73.0% vs. 44.2%, p = 0.002), be scheduled for anticoagulation therapy on discharge (45.9% vs. 1.7%, p < 0.001), and have prophylactic filter insertion for surgery or high-risk patients (37.8% vs. 7.5%, p < 0.001), as well as less likely to have a history of malignancy (16.2% vs. 40.0%, p = 0.008) or any contraindication to anticoagulation therapy (70.3% vs. 92.5%, p = 0.001). Predictors for filter retrieval were patient age of <70 years (odds ratio [OR] = 3.55, p = 0.033), no history of malignancy (OR = 0.15, p = 0.010), scheduled for anticoagulation therapy on discharge (OR = 63.08, p < 0.001), prophylactic filter insertion for surgery or high-risk patients (OR = 14.57, p < 0.001), and contraindication to anticoagulation owing to postoperation within 2 weeks (OR = 6.19, p = 0.004). Only 23 of 37 patients with a retrieval request attempted retrieval, with 17 being successful. Compared with patients with failed retrieval, those with successful retrieval had a shorter mean retrieval interval (27.2 vs. 77.7 days, p = 0.014). The success rate was higher when retrieval was within 23 days of insertion compared with a longer time (100% vs. 53.8%, p = 0.019).
Conclusion: Predictors for filter retrieval were patient age of <70 years, no history of malignancy, scheduled for anticoagulation therapy on discharge, prophylactic filter insertion for surgery or high-risk patients, and contraindication to anticoagulation owing to postoperation within 2 weeks. A shorter retrieval interval was associated with successful retrieval.
Authors’ affiliation:
WH Chong, KL Siu, WS Wan, KY Chan, CB Tan: Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong
中文摘要
回收下腔靜脈過濾器：一所分區醫院7年經驗回顧
莊永豪、蕭廣樂、溫詠雪、陳嘉煜、陳崇文
目的：通過比較有和沒有請求回收下腔靜脈（IVC）過濾器的患者來確定成功回收IVC過濾器的預測因子。
方法：回顧2008年1月至2014年12月間在一所分區醫院接受植入IVC Cordis OptEase過濾器的患者。
結果：64名男性和93名女性年約15至94（平均，66.7）歲的患者被分類為有（n = 37）或沒有（n = 120）要求回收IVC濾過器。與沒有要求回收的患者相比，有要求回收的患者傾向<70歲（73.0%對44.2%，p = 0.002）、計劃出院後接受抗凝治療（45.9%對1.7%，p < 0.001）、預防性地為手術植入過濾器或高風險患者（37.8%對7.5%，p < 0.001）。有要求回收的患者不傾向有惡性病史（16.2%對40.0%，p = 0.008）或任何抗凝治療禁忌（70.3%對92.5%，p = 0.001）。回收過濾器的預測因子為年齡<70歲（比值比[OR] = 3.55，p = 0.033）、沒有惡性腫瘤史（OR = 0.15，p = 0.010）、計劃出院後接受抗凝治療（OR = 63.08，p < 0.001）、預防性地為手術植入過濾器或高風險患者（OR = 14.57，p < 0.001）、及由於術後2週內的抗凝禁忌（OR = 6.19，p = 0.004）。37名要求回收的患者中只有23名嘗試回收，其中17名成功。與回收失敗的患者相比，回收成功的患者平均回收間隔較短（27.2對77.7天，p = 0.014）。於23天內回收成功率較更久間隔高（100%對53.8%，p = 0.019）。
結論：回收過濾器的預測因子為年齡<70歲、沒有惡性腫瘤史、計劃出院後接受抗凝治療、預防性地為手術植入過濾器或高風險患者及由於術後2週內的抗凝禁忌。較短的回收間隔與成功回收有關聯。