Elica Inagaki1, Alik Farber2, Mohammad H Eslami2, Jeffrey J Siracuse2, Denis V Rybin3, Shayna Sarosiek4, J Mark Sloan4, Jeffrey Kalish5. 1. Department of Surgery, Boston Medical Center, Boston, Mass. 2. Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, Mass. 3. Department of Biostatistics, Boston University School of Public Health, Boston, Mass. 4. Section of Hematology and Oncology, Department of Medicine, Boston University and Boston Medical Center, Boston, Mass. 5. Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, Mass. Electronic address: jeffrey.kalish@bmc.org.
Abstract
OBJECTIVE: The option to retrieve inferior vena cava (IVC) filters has resulted in an increase in the utilization of these devices as stopgap measures in patients with relative contraindications to anticoagulation. These retrievable IVC filters, however, are often not retrieved and become permanent. Recent data from our institution confirmed a historically low retrieval rate. Therefore, we hypothesized that the implementation of a new IVC filter retrieval protocol would increase the retrieval rate of appropriate IVC filters at our institution. METHODS: All consecutive patients who underwent an IVC filter placement at our institution between September 2003 and July 2012 were retrospectively reviewed. In August 2012, a multidisciplinary task force was established, and a new IVC filter retrieval protocol was implemented. Prospective data were collected using a centralized interdepartmental IVC filter registry for all consecutive patients who underwent an IVC filter placement between August 2012 and September 2014. Patients were chronologically categorized into preimplementation (PRE) and postimplementation (POST) groups. Comparisons of outcome measures, including the retrieval rate of IVC filters along with rates of retrieval attempt and technical failure, were made between the two groups. RESULTS: In the PRE and POST groups, a total of 720 and 74 retrievable IVC filters were implanted, respectively. In the POST group, 40 of 74 filters (54%) were successfully retrieved compared with 82 of 720 filters (11%) in the PRE group (P < .001). Furthermore, a greater number of IVC filter retrievals were attempted in the POST group than in the PRE group (66% vs 14%; P < .001). No significant difference was observed between the PRE and POST groups for technical failure (17% vs 18%; P = .9). CONCLUSIONS: The retrieval rate of retrievable IVC filters at our institution was significantly increased with the implementation of a new IVC filter retrieval protocol with a multidisciplinary team approach. This improved retrieval rate is possible with minimal dedication of resources and can potentially lead to a decrease in IVC filter-related complications in the future.
OBJECTIVE: The option to retrieve inferior vena cava (IVC) filters has resulted in an increase in the utilization of these devices as stopgap measures in patients with relative contraindications to anticoagulation. These retrievable IVC filters, however, are often not retrieved and become permanent. Recent data from our institution confirmed a historically low retrieval rate. Therefore, we hypothesized that the implementation of a new IVC filter retrieval protocol would increase the retrieval rate of appropriate IVC filters at our institution. METHODS: All consecutive patients who underwent an IVC filter placement at our institution between September 2003 and July 2012 were retrospectively reviewed. In August 2012, a multidisciplinary task force was established, and a new IVC filter retrieval protocol was implemented. Prospective data were collected using a centralized interdepartmental IVC filter registry for all consecutive patients who underwent an IVC filter placement between August 2012 and September 2014. Patients were chronologically categorized into preimplementation (PRE) and postimplementation (POST) groups. Comparisons of outcome measures, including the retrieval rate of IVC filters along with rates of retrieval attempt and technical failure, were made between the two groups. RESULTS: In the PRE and POST groups, a total of 720 and 74 retrievable IVC filters were implanted, respectively. In the POST group, 40 of 74 filters (54%) were successfully retrieved compared with 82 of 720 filters (11%) in the PRE group (P < .001). Furthermore, a greater number of IVC filter retrievals were attempted in the POST group than in the PRE group (66% vs 14%; P < .001). No significant difference was observed between the PRE and POST groups for technical failure (17% vs 18%; P = .9). CONCLUSIONS: The retrieval rate of retrievable IVC filters at our institution was significantly increased with the implementation of a new IVC filter retrieval protocol with a multidisciplinary team approach. This improved retrieval rate is possible with minimal dedication of resources and can potentially lead to a decrease in IVC filter-related complications in the future.
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