Inferior vena cava filters: a review

José Ángel Barajas-Colón, Baltazar Barrera-Mera, Rodrigo Banegas-Ruiz, José Juan Vargas-Morales, Elvira Barrera-Calva, Daniel Benito Castillo-Martínez, Obed Horacio Grajeda-Chávez, Christian E. Soulé-Martínez, Francisco Fabián Gómez-Mendoza, Rodrigo Mendoza-Aceves, Mariana del Carmen Radilla-Flores, Nelson Niels Espinosa-Queb, Alejandro Ángel Corona-Figueroa, Bruno Andrés Salazar-Trujillo, Alan I. Valderrama-Treviño


Venous thromboembolism is an entity that ranges from deep vein thrombosis to pulmonary embolism, both are highly prevalent diseases in our environment and potentially fatal. The intention of this review is to compile information regarding the indications, contraindications, complications and comparison of different therapeutic methods in order to create an algorithm. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to inferior vena cava filters. Venous thrombosis manifested as deep vein thrombosis or pulmonary embolism is a highly prevalent disease in our setting with high morbidity and mortality. Currently, different therapeutic options have been presented to address this pathology, in this review we focus on the developments regarding the use of vena cava filters. Reviewing the indications for the placement of a vena cava filter, we find absolute indications such as a contraindication to anticoagulation and high risk of massive pulmonary embolism. Pulmonary thromboembolism is a disease with high prevalence and mortality, we have highly effective and novel treatments such as the vena cava filter, patients should be selected carefully always taking into account the absolute and relative indications.


Inferior vena cava filter, Venous thromboembolism, Deep venous insufficiency, Pulmonary embolism, Removable filters, Permanent filters

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Ha CP, Rectenwald JE. Inferior Vena Cava Filters Current Indications, Techniques, and Recommendations. Surg Clin N Am. 2018;293-319.

Spencer FA, Emery C, Lessard D, Anderson F, Emani S, Aragam J et al. The Worcester Venous Thromboembolism Study. A population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med. 2006;722-7.

Ramírez-Arias E, Rosas-Peralta M, Borrayo-Sánchez G, Moreno-Ruiz LA, Arenas-Fonseca JG, Arzola-Covarrubias VM, et al. Tromboembolismo pulmonar: experiencia reciente de 4 años en un hospital de cardiología. Rev Med Inst Mex Seg Soc. 2017;52-62.

Kroger K, Bupper J, Moerchel C, Kienitz MC, Schubert I. Prevalence and economic burden of pulmonary embolism in Germany. Vascular Medicine. 2012;17(5):303-9.

Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12(8):464-74.

Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163:1711.

Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: A major contributor to global disease burden. Thrombosis Research. 2014;134:931-8.

Goldhaber SZ, Grodstein F, Stampfer MJ. A prospective study of risk factors for pulmonary embolism in women. JAMA. 1997;277:642.

Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;315-52.

Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber S, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141.

Gomez-Outes A, Terleira-Fernandez AI, Lecumberri R, Suarez-Gea ML, Vargas-Castrillon E. Direct oral anticoagulants in the treatment of acute venous thromboembolism: a systematic review and meta-analysis. Thromb Res. 2014;774-82.

Engelberger RP, Stuck A, Spirk D, Willenberg T, Haine A, Periard D, et al. Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis: 1-year follow-up data of a randomized-controlled trial. J Thromb Haemost. 2017;1351-60.

Demelo P, Pulfer M, Toro-Cervera J, González-Leyte M, Echenagusía-Boyra M. Trombólisis fármaco-mecánica; una técnica a considerar en el tratamiento de la trombosis venosa profunda ileofemoral aguda. Angiología. 2017;69.

Lin PH, Zhou W, Dardik A, Mussa F, Kougias P, Hedayati N et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg. 2006;192:782-8.

Hull RD, Raskob GE, Pineo GF, Trowbridge A, Elliott C, Hall J, et al. Subcutaneous low-molecular-weight heparin compared with conti- nuous intravenous heparin in the treatment of proxi- mal-vein thrombosis. N Engl J Med. 1992;975-82.

Donato G, Pasqui E, Setacci F, Palascino G, Nigi L, Fondelli C et al. Acute on chronic limb ischemia: from surgical embolectomy and thrombolysis to endovascular options. Semin vasc surg. 2018;66-75.

Martínez-Martínez J, Miguel SJA, Nora LHE, Hugo MVC, Anuar FM et al. ¿Debemos abandonar la trombectomía quirúrgica en caso de flegmasia cerúlea dolens en la era endovascular? Rev Mex Angiol. 2018;39-43.

Andrew DW, Kai T, Crane C. Ligation of the inferior vena cava for thromboembolism. Surgery. 1958;24-44.

Holly BP, Funkai B, Lessne ML. Inferior Vena Cava Filters Why, Who, and for How Long? Clin Chest Med. 2018;645-50.

DeYoung E, Minocha J. Inferior vena cava filters: guidelines, best practice, and expanding indications. Semin Intervent Radiol. 2016;65-70.

Caplin DM, Nikolic B, Kalva SP, Ganguli S, Saad W, Zuckerman D, et al. Quality improvement guidelines for the performance of inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol. 2011;1499-506.

Michael R, Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Samuel Z et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;1788-830.

Molvar C. Inferior vena cava filtration in the management of venous thromboembolism: filtering the data. Semin Intervent Radiol. 2012;204-17.

Rottenstreich A, Bar-Shalom R, Bloom AI, Kalish Y. Endovascular infection following inferior vena cava (IVC) filter insertion. J Thromb Thrombolysis. 2015;452-7.

Brateanu A, Patel K, Chagin K, Pinchapong T, Pojchawan Y, Gautam V, et al. Probability of developing proximal deep-vein thrombosis and/or pulmonary embolism after distal deep-vein thrombosis. Thromb Haemost. 2016;115:608.

De Martino RR, Wallaert JB, Rossi AP, Zbehlik A, Suckow B, Walsh D. A meta-analysis of anticoagulation for calf deep venous thrombosis. J Vasc Surg. 2012;228.

Sales CM, Haq F, Bustami R, Sun F. Management of isolated soleal and gastrocnemius vein thrombosis. J Vasc Surg. 2010;1251.

Ebadi H, Righini M. Management of distal deep vein thrombosis. Thromb Res. 2016;48-55.

Ni H, Win LL. Retrievable inferior vena cava filters for venous thromboembolism. ISRN Radiol. 2013;959.

Morales JP, Li X, Irony TZ, Ibrahim N, Moynahan M, Cavanaugh K. Decision analysis of retrievable inferior vena cava filters in patients without pulmonary embolism. J Vasc Surg Venous Lymphat Disord. 2013;376.

Dake MD, Murphy TP, Kreamer AH, Darcy M, Sewall K, Curi M, et al. SENTRY Trial Investigators. One-year analysis of the prospective multicenter sentry clinical trial: safety and effectiveness of the Novate Sentry bioconvertible inferior vena cava filter. J Vasc Interv Radiol. 2018;1350.

Kaufman JA. Optional vena cava filters: what, why, and when. Vascular. 2007;304-13.

Rajasekhar A, Streiff MB. Vena cava filters for management of venous thromboembolism: a clinical review. Blood Rev. 2013;225-41.

Berczi V, Bottomley JR, Thomas SM, Gaines P, Cleveland T. Long-term retrievability of IVC filters: should we abandon permanent devices? Cardiovasc Intervent Radiol. 2007;820-7.

Grassi C, Swan T, Cardella J, Meranze S, Oglevie S, Omary R et al. Quality improvement guidelines for percutaneous permanent inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol. 2001;137-41.

Angel LF, Tapson V, Galgon RE, Restrepo MI, Kaufman J. Systematic review of the use of retrievable inferior vena cava filters. J Vasc Interv Radiol. 2011;1522-30.

Malgor RD, Labropoulos N. A systematic review of symptomatic duodenal perforation by inferior vena cava filters. J Vasc Surg. 2012;856-61.

Ha CP, Rectenwald JE. Inferior vena cava filters: current indications, techniques, and recommendations. Surg Clin North Am. 2018;293-319.

Food and drug administration. Removing retrievable inferior vena cava filters: FDA safety communication. 2014.

Lee MJ, Valenti D, de Gregorio MA, Minocha J, Rimon U, Pellerin O. The cirse retrievable ivc filter registry: retrieval success rates in practice. Cardiovasc Interv Radiol. 2015;1502-7.

Minocha J, Idakoji I, Riaz A, Karp J, Gupta R, Chrisman HB et al. Improving inferior vena cava filter retrieval rates: impact of a dedicated inferior vena cava filter clinic. J Vasc Interv Radiol. 2010;1847-51.

Ghatan C, Ryu R. Permanent versus retrievable inferior vena cava filters: rethinking the “one-filter-for-all” approach to mechanical thromboembolic prophylaxis. Semin Intervent Radiol. 2016;75-8.

Doe C, Ryu R. Anatomic and technical considerations: inferior vena cava filter placement. Semin Intervent Radiol. 2016;33.

Holly B, Funaki B, Lessne M. Inferior Vena cava filters. Why, who and for how long? Clin Chest Med. 2018;645-50.

Deso SE, Idakoji IA, Kuo WT. Evidence-based evaluation of inferior vena cava filter complications based on filter type. Semin Intervent Radiol. 2016;93-100.

Imberti D, Ageno W, Manfredini R, Fabbian F, Salmi R, Duce R et al. Interventional treatment of venous thromboembolism: a review. Thromb Res. 2012;418-25.

Andreoli JM, Lewandowski RJ, Vogelzang RL, Ryu R. Comparison of complication rates associated with permanent and retrievable inferior vena cava filters: a review of the MAUDE database. J Vasc Interv Radiol. 2014;1181-5.

Joe WB, Larson ML, Madassery S, Devane M, Holly B, Sing R, et al. Bowel Penetration by Inferior Vena Cava Filters: Feasibility and Safety of Percutaneous Retrieval. AJR Am J Roentgenol. 2019;213:1152.

Ye K, Lu X, Li W, Liu X, Qin K, Liu G et al. Outcomes of Stent Placement for Chronic Occlusion of a Filter-bearing Inferior Vena Cava in Patients with Severe Post-thrombotic Syndrome. Eur J Vasc Endovasc Surg. 2016;52:839.

Grosse SD, Nelson RE, Nyarko KA, Richardson L, Raskob G. The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs. Thromb Res. 2016;137:3.

Holmes CE, Bambace NM, Lewis P, Callas P, Cushman M. Efficacy of a short course of complex lymphedema therapy or graduated compression stocking therapy in the treatment of post-thrombotic syndrome. Vasc Med. 2014;19:42.

Henke PK, Comerota AJ. An update on etiology, prevention, and therapy of postthrombotic syndrome. J Vasc Surg. 2011;53:500.

Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. 1998;409-15.

Hemmila MR, Osborne NH, Henke PK. Prophylactic inferior vena cava filter placement does not result in a survival benefit for trauma patients. Ann Surg. 2015;577-85.

Haut ER, Garcia LJ, Shihab HM, Brotman D, Stevens K, Sharma R, et al. The effectiveness of prophylactic inferior vena cava filters in trauma patients: a systematic review and meta-analysis. JAMA Surg. 2014;194-202.

Rogers FB, Cipolle MD, Velmahos G, Luchette F. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. J Trauma. 2002;142-64.

Levy MM, Albuquerque F, Pfeifer JD. Low incidence of pulmonary embolism associated with upperextremity deep venous thrombosis. Ann Vasc Surg. 2012;964-72.

Munoz FJ, Mismetti P, Poggio R, Valle R, Barron M, Guil M, et al. Clinical outcome of patients with upper-extremity deep vein thrombosis: results from the RIETE registry. Chest. 2008;143-8.

Ascher E, Hingorani A, Tsemekhin B, Yorkovich W, Gunduz Y. Lessons learned from a 6-year clinical experience with superior vena cava Greenfield filters. J Vasc Surg. 2000;881-7.

Sonavane S, Milner D, Singh S, Abdel A, Shahir K, Chaturvedi A. Comprehensive Imaging review of the superior vena cava. Radiographics. 2015;1873-92.

Harris SA, Velineni R, Davies AH. Inferior Vena Cava Filters in Pregnancy: A Systematic Review. J Vasc Interv Radiol. 2016;354-60.

Castro P, Vázquez JA, Echevarria DA, Zúñiga CD, Moctezuma L, Hernández JL. Muerte materna por tromboembolia pulmonar. Rev Fac Med. 2019;28-38.

Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA et al. Pregnancy-related mortality surveillance–United States, 1991–1999. MMWR Surveill Summ. 2003;1-8.

Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence- Based Clinical Practice Guidelines. Chest. 2012;141.

Khorana AA. Venous thromboembolism and prognosis in cancer. Thromb Res. 2010;490-3.

Brunson A, Ho G, White R, Wun T. Inferior vena cava filters inpatients with cancer and venous thromboembolism (VTE): patterns of use and outcomes. Thromb Res. 2016;S132-41.

Carrier M, Khorana A, Zwicker J, Noble S, Lee A. Management of challenging cases of patients with cancer-associated thrombosis including recurrent thrombosis and bleeding: guidance from the SSC of the ISTH. J Thromb Haemost. 2013;1760-5.

Lynch FC. A method for following patients with retrievable inferior vena cava filters: results and lessons learned from the first 1,100 patients. J Vasc Interv Radiol. 2011;1507-12.

Renno A, Khateeb F, Kazan V, Qu W, Gollapudi A, Aplin B et al. A single center experience with retrievable IVC filters. Vascular. 2015;350-57.