Utility of Retrievable Inferior Vena Cava Filters: A Systematic Literature Review and Analysis of the Reasons for Nonretrieval of Filters with Temporary Indications.
OBJECTIVE
To investigate the use of retrievable inferior vena cava (IVC) filters in the current practice and analyze the causes of filter left in situ despite initial plans for retrieval.


METHODS
A systematic search of all English-language studies of retrievable IVC filters was conducted, including clinical trials and observational studies published between January 1984 and March 2016.


RESULTS
A total of 103 studies were identified, including 10 filter models in 20,319 patients. Placement indications were reported for 11,128 (54.8%) patients, including therapeutic (n = 6270; 56.3%) and prophylactic (n = 4858; 43.7%) indications. A total of 13,224 (65.1%) filters were left as permanent devices; 7095 (34.9%) filters were removed. The reasons for filter nonretrieval among the 5308 (40.1%) reported cases were primary permanent indication (21.2%; 1127/5308), death (19.4%; 1031/5308), ongoing pulmonary embolism (PE) protection (19.0%; 1011/5308), failed retrieval (13.7%; 725/5308), loss to follow-up (13.0%; 689/5308), discontinued care (4.4%; 235/5308), physician oversight (4.0%; 213/5308), patient morbidity (2.8%; 149/5308), and patient refusal (2.4%; 128/5308). A total of 7820 patients presented for filter retrieval, and 7095 filters (90.7%) were successfully removed, with a mean indwelling time of 106.6 ± 47.3 days. Breakthrough PE was reported in 2.1% (191/9169) of patients. Filter tilt, recurrent deep vein thrombosis, penetration, IVC thrombosis, migration, and fracture occurred in 7.7% (798/10,348), 7.1% (362/5092), 5.4% (379/7001), 3.9% (345/8788), 1.4% (160/11,679), and 0.5% (50/9509) of patients, respectively.


CONCLUSIONS
Approximately two-thirds of retrievable filters were not retrieved even though more than 85% of the filters were initially intended for temporary use. The major reasons for filter left in situ despite initial plans for retrieval were death, need for ongoing PE protection, failed retrieval, loss to follow-up, discontinued care, and physician oversight.
['Jia|Zhongzhi|Z|', 'Fuller|Tyler A|TA|', 'McKinney|J Mark|JM|', 'Paz-Fumagalli|Ricardo|R|', 'Frey|Gregory T|GT|', 'Sella|David M|DM|', 'Van Ha|Thuong|T|', 'Wang|Weiping|W|']
D000328:Adult D000368:Aged D020878:Device Removal D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D016306:Vena Cava Filters
Inferior vena cava Filter Pulmonary embolism