User login
HUNTINGTON BEACH, CALIF. – Retrievable inferior vena cava filters should be removed once the acute risk of pulmonary embolism or deep venous thrombosis has passed, instead of being left in patients indefinitely, according to Dr. John Curci.
Despite the dearth of data about long-term risks, there are reports of filters thrombosing, migrating, fragmenting, and embolizing, with severe complications. Use of the filters has grown in recent years, and currently in U.S. patients, only about half of them are removed when no longer needed, he said (J. Hosp. Med. 2009;4:441-8).
"Should you remove the filters? I think just based on the fact that we don’t have good long-term data, the answer is yes," he said, noting that filter removal is "fast, easy, and billable," with potentially an 85% or better retrieval rate.
About 60 embolizations to the heart have been reported over the past 15 years. Such reports "need to be scaring us all a little bit until we really know what [the risks] are," Dr. Curci said (J. Invasive Cardiol. 2009;21:606-10).
Dr. Curci, a vascular surgeon at Washington University in St. Louis, Mo., made the case for removal of the filters during the meeting.
Early in their development, the filters were placed therapeutically in patients with pulmonary embolisms (PEs) or deep venous thromboses (DVTs) or histories of them.
With the development of retrievable filters, there’s been a shift over the past 15 years to prophylactic placement when the risk of DVT or PE is anticipated to be high, or when there is a risk of bleeding with anticoagulation.
"This has led to a lot of excitement about putting these filters in, and so we are increasing [their] use," Dr. Curci said. However, the risk of fatal or debilitating PEs or DVTs in the absence of any preceding symptoms is low, and usually short-lived.
Because of that, "the safety bar must be [correspondingly] high" for filters meant to prevent them, he said.
It is in that context that rare reports of filter fractures and embolisms become important. In one of the few attempts to assess long-term risks, 80 patients with filters placed between April 2004 and January 2009 were fluoroscoped to assess filter integrity. Filters had fractured and fragmented in 13 patients and embolized in 7, including 5 patients with embolization to the heart.
Three of those five patients experienced life-threatening ventricular tachycardia and/or tamponade. One patient died (Arch. Intern. Med. 2010;170:1827-31).
"That’s not minor, to have a piece of your filter in your heart. We not only have to think about [filter risks] in the short term, but also in the long term" and "whether placement is justified" in the first place, Dr. Curci said.
He said he has no disclosures.
HUNTINGTON BEACH, CALIF. – Retrievable inferior vena cava filters should be removed once the acute risk of pulmonary embolism or deep venous thrombosis has passed, instead of being left in patients indefinitely, according to Dr. John Curci.
Despite the dearth of data about long-term risks, there are reports of filters thrombosing, migrating, fragmenting, and embolizing, with severe complications. Use of the filters has grown in recent years, and currently in U.S. patients, only about half of them are removed when no longer needed, he said (J. Hosp. Med. 2009;4:441-8).
"Should you remove the filters? I think just based on the fact that we don’t have good long-term data, the answer is yes," he said, noting that filter removal is "fast, easy, and billable," with potentially an 85% or better retrieval rate.
About 60 embolizations to the heart have been reported over the past 15 years. Such reports "need to be scaring us all a little bit until we really know what [the risks] are," Dr. Curci said (J. Invasive Cardiol. 2009;21:606-10).
Dr. Curci, a vascular surgeon at Washington University in St. Louis, Mo., made the case for removal of the filters during the meeting.
Early in their development, the filters were placed therapeutically in patients with pulmonary embolisms (PEs) or deep venous thromboses (DVTs) or histories of them.
With the development of retrievable filters, there’s been a shift over the past 15 years to prophylactic placement when the risk of DVT or PE is anticipated to be high, or when there is a risk of bleeding with anticoagulation.
"This has led to a lot of excitement about putting these filters in, and so we are increasing [their] use," Dr. Curci said. However, the risk of fatal or debilitating PEs or DVTs in the absence of any preceding symptoms is low, and usually short-lived.
Because of that, "the safety bar must be [correspondingly] high" for filters meant to prevent them, he said.
It is in that context that rare reports of filter fractures and embolisms become important. In one of the few attempts to assess long-term risks, 80 patients with filters placed between April 2004 and January 2009 were fluoroscoped to assess filter integrity. Filters had fractured and fragmented in 13 patients and embolized in 7, including 5 patients with embolization to the heart.
Three of those five patients experienced life-threatening ventricular tachycardia and/or tamponade. One patient died (Arch. Intern. Med. 2010;170:1827-31).
"That’s not minor, to have a piece of your filter in your heart. We not only have to think about [filter risks] in the short term, but also in the long term" and "whether placement is justified" in the first place, Dr. Curci said.
He said he has no disclosures.
HUNTINGTON BEACH, CALIF. – Retrievable inferior vena cava filters should be removed once the acute risk of pulmonary embolism or deep venous thrombosis has passed, instead of being left in patients indefinitely, according to Dr. John Curci.
Despite the dearth of data about long-term risks, there are reports of filters thrombosing, migrating, fragmenting, and embolizing, with severe complications. Use of the filters has grown in recent years, and currently in U.S. patients, only about half of them are removed when no longer needed, he said (J. Hosp. Med. 2009;4:441-8).
"Should you remove the filters? I think just based on the fact that we don’t have good long-term data, the answer is yes," he said, noting that filter removal is "fast, easy, and billable," with potentially an 85% or better retrieval rate.
About 60 embolizations to the heart have been reported over the past 15 years. Such reports "need to be scaring us all a little bit until we really know what [the risks] are," Dr. Curci said (J. Invasive Cardiol. 2009;21:606-10).
Dr. Curci, a vascular surgeon at Washington University in St. Louis, Mo., made the case for removal of the filters during the meeting.
Early in their development, the filters were placed therapeutically in patients with pulmonary embolisms (PEs) or deep venous thromboses (DVTs) or histories of them.
With the development of retrievable filters, there’s been a shift over the past 15 years to prophylactic placement when the risk of DVT or PE is anticipated to be high, or when there is a risk of bleeding with anticoagulation.
"This has led to a lot of excitement about putting these filters in, and so we are increasing [their] use," Dr. Curci said. However, the risk of fatal or debilitating PEs or DVTs in the absence of any preceding symptoms is low, and usually short-lived.
Because of that, "the safety bar must be [correspondingly] high" for filters meant to prevent them, he said.
It is in that context that rare reports of filter fractures and embolisms become important. In one of the few attempts to assess long-term risks, 80 patients with filters placed between April 2004 and January 2009 were fluoroscoped to assess filter integrity. Filters had fractured and fragmented in 13 patients and embolized in 7, including 5 patients with embolization to the heart.
Three of those five patients experienced life-threatening ventricular tachycardia and/or tamponade. One patient died (Arch. Intern. Med. 2010;170:1827-31).
"That’s not minor, to have a piece of your filter in your heart. We not only have to think about [filter risks] in the short term, but also in the long term" and "whether placement is justified" in the first place, Dr. Curci said.
He said he has no disclosures.
FROM THE ANNUAL ACADEMIC SURGICAL CONGRESS