Complications of Vena Cava Filters

Publisher Summary This chapter explores the thrombonic complications of vena cava filters. Venous thromboembolism (VTE) is optimally treated by anticoagulation. When anticoagulation must be withheld, inferior vena cava (IVC) interruption affords protection against major embolic events likely to be life threatening. IVC interruption has historically progressed from cava ligation to plication, caval clips, surgically inserted caval umbrellas and filters, and finally, to percutaneously inserted filters. Currently available devices include permanent filters that once deployed remain in place indefinitely, and optionally retrievable filters that may be left in place permanently or may be removed within a specified time frame (weeks to months depending on the device). Complications associated with the historic methods of caval interruption and devices have driven, and will continue to encourage, the modification and design of devices that have limited endothelial cell interactions, require smaller deployment tools, and use imaging friendly materials with reduced thrombogenicity. Current accepted indications for IVC filter use include contraindications to anticoagulation (active bleeding or recent hemorrhage), complications of anticoagulation, or thromboembolism (pulmonary embolism or recurrent/propagation of deep venous thrombosis) despite adequate anticoagulation.