Selection of vena cava filters in traumatic deep venous thrombosis

Objective:To explore the indicators of vena cava filters(VCFs) implementation in case of deep venous thrombosis(DVT) secondary to lower extremity trauma and how to select among different types of VCFs.Methods:Based on the previous VCF guideline,DVT patients secondary to lower extremity trauma treated in our hospital in the year of 2010 were categorized into the following subgroups and analyzed separately: implanted temporary VCFs;implanted retrievable VCFs;implanted permanent VCFs.Results:Totally 4 544 subjects were screened and 968 patients were diagnosed with DVT.The DVT incidence is 21.3%.VCFs were implanted in 296 patients.Among them,121 patients received temporary VCFs(40.9%),56 subjects received retrievable VCFs(18.9%) and permanent VCFs were implanted in 119 cases(40.2%).No fatal pulmonary embolism(PE) or significant symptomatic PE were identified while VCFs were implanted.Post surgery,anti-coagulants were administrated and subjects were followed up to three to six month.Two DVT relapses were identified during follow-up.Conclusion:If acute DVT was diagnosed in lower limb trauma patients,VCF implantation before surgery can greatly reduce the incidence of fatal PE.Since the risk of thromboembolism in trauma patients are transient,temporary VCFs are the first choice.Retrievable VCFs are indicated in elderly patients or patients with severe cardiac-pulmonary complications.VCF implantation is not obligatory if thrombus was identified post-surgery or obsolete in nature identified before surgery.