PB2433 OUTCOME AND COMPLICATIONS OF INFERIOR VENA CAVA FILTER INSERTION: TERTIARY REFERRAL CENTER EXPERIENCE
Authors: G. E. Gmati, R. AlRasheed, G. Bukhary, N. Shaheen, A. Immanuel, A. Alaskar, R. Salman
Journal: HemaSphere (2019)

Background: Pulmonary embolism (PE) remains a source of significant mortality and morbidity all over the world and in Saudi Arabia, the exact incidence remains unknown, however, deaths due to venous thromboembolism (VTE) and PE was estimated 10-12% in hospitalized patients. While most patients are managed by oral anticoagulants; many risk factors preclude their use and recurrent PE remains a major risk. Inferior vena cava (IVC) filters has been introduced since 1969, many filter types were developed since then which had better outcomes and less complications. Aims: The aim of the study was to identify the indications and complications of IVC filter insertion as well as to estimate the success rate of IVC filter insertion performed at King Abdul-Aziz Medical City (KAMC), Riyadh Saudi Arabia. Methods: A retrospective cohort design was employed. The medical charts of patients who had IVC filter insertion from 2011-2016 were reviewed. The main referring departments for the procedure were Internal Medicine, Medical Oncology, Orthopedics, and Emergency Room. Demographic variables, indications of insertion, outcomes, and complications of IVC filter insertion were collected. All patients underwent the procedure in the intervention radiology suit. Categorical variables were summarized as proportion and percentage. Continuous variables were summarized as mean and standard deviation. Data was analyzed using SAS version 9.2. Results: Total of 411 patients were eligible based on the inclusion criteria. Male to female distribution was 61.07% to 38.93% respectively. Main indication for filter insertion was calculated based on the latest Society of International Radiology (SIR) guidelines. The most common indication of insertions was the contraindication to oral anticoagulants prescription in 131 (37.86%) patient followed by PE or DVT and transient inability to anticoagulate in 65 (18.79%) patient while 65 (18.79%) patient did not have a clear indication documented. The types of filters used were Optease filters in 308 (75%) patient followed by Denali in 62 (15%) patient and other less commonly used filters for instance Celect filters in 41 (10%) patients. Anatomically, 400 (97.32%) filter were inserted infrarenally, while 9 (2.20%) filters were inserted suprarenally and 2 (0.49%) were inserted in the common iliac vein. The rate of Insertion problems was 16.1% (n = 66). Filter migration was reported in 2 patients (0.49%). Retrieval was successful in 153 (84.97%) of patients who were followed up. IVC filter penetration occurred in 2 (0.49%) of our patients. No report of immediate complications in 344 (83.90%) patient. Immediate complications reported were in 67 (16.1%) patient and the most common one was tilting in 56 (13.66%) patient. Mean duration of filter in situ was 91.91 days. Loss of follow up due to death unrelated to procedure occurred in 113 (27.90%) patient and in 87 (21.48%) patient follow up lost due to other reasons. The most common late complication was thrombosis in 38 (9.38%) patient. IVC thrombus complicated retrieval in 8 (1.97%) patients) and failure to retrieve due to other comorbidities and implications occurred in 6 (1.48%) patients. Summary/Conclusion: IVC filter placement in our institution is considered to be a safe procedure with minimal complications and high success rate of filter retrieval. Multicenter study is needed to compare the IVC insertion outcomes across facilities.