Long-term complications of inferior vena cava filters.

OBJECTIVE: Some inferior vena cava filter (IVCF) complications only manifest after prolonged dwell time (IVCF fracture, inferior vena cava [IVC] occlusion, and IVC perforation). Incidence of these complications is often based on mathematical projections given the lack of long-term imaging follow-up. The aim of this study was to assess the incidence of long-term complications of IVCFs using ideal imaging, contrast-enhanced computed tomography (CT).

METHODS: From 2007 to 2009, 3303 IVCFs were placed across a large healthcare region. Only patients with contrast enhanced CTs of the abdomen at a minimum of 4 years post-IVCF implantation were selected. A retrospective observational study was performed in 96 patients. Primary outcomes were prevalence and predictive factors for IVCF fracture, IVC thrombosis, and IVC perforation.

RESULTS: Of 96 patients, 39 had permanent IVCFs and 57 had retrievable IVCFs. Mean dwell time at most recent CT scan was 61 months. Overall rate of fracture was 14% with the majority (92%) in Cordis OptEase and TrapEase filters (Cordis, Fremont, Calif; P < .0001). Overall rate of partial/complete IVC occlusion was 13% (7.3% total and 5.2% partial). IVC perforation rates were higher among retrievable devices (70%) compared with permanent devices (15%; P < .0001). Perforation involving retroperitoneal structures was 68% among conical retrievable devices and 5% among permanent devices (P < .0001).

CONCLUSIONS: Long-term complications related to chronic IVCFs are relatively common, and the incidence of fracture and IVC perforation varies with device type. Higher rates of fracture were seen with the Cordis OptEase and TrapEase filters, whereas higher rate and degree of IVC perforation were seen with retrievable conical type devices.