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Permanent and Temporary Inferior Vena Cava Filters


Inferior vena cava (IVC) filters are placed for the sole purpose of preventing a potentially fatal pulmonary embolism (PE). Development and introduction of retrievable IVC filters has been associated with a general liberalization of the indications for IVC filters. In fact, the number of IVC filters placed for extended indications or prophylaxis in the absence of demonstrable venous thromboembolism (VTE) increased more than 80% from 1998 to 2005.

Indications for Placing Filters

Indications for placing IVC filters are generally classified into three categories: absolute (or classic) indications, generally accepted relative indications, and extended (prophylactic) indications. Absolute and relative indications for placing IVC filters require the presence of VTE; the extended indications do not, and filters placed for this indication are prophylactic ( Box 1 ). There is general agreement among physicians regarding the classic indications for filter placement. However, considerable controversy exists around the extended indications for filter placement.

BOX 1
Indications for Placing Inferior Vena Cava Filters

Absolute (Classic) Indications ( Requires Presence of VTE )

  • DVT or PE while on therapeutic anticoagulation

  • Complication of anticoagulation

  • DVT or PE with contraindication to anticoagulation

  • Patients undergoing pulmonary thromboembolectomy

Relative Indications ( Requires Presence of VTE )

  • Thromboembolic disease with limited cardiopulmonary reserve

  • Patients with poor compliance to medications

  • Large, free-floating iliocaval thrombus longer than 6 cm

  • Patients with ataxia or at high risk for falls

  • Protection from PE during thrombolysis in patients with a large clot burden

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