Caval Penetration by Inferior Vena Cava Filters A Systematic Literature Review of Clinical Significance and Management

Background —Limited penetration into the caval wall is an important securing mechanism for inferior vena cava (IVC) filters; however, caval penetration can also cause unintentional complications. The aim of this study was to assess the incidence, severity, clinical consequences, and management of filter penetration across a range of commercially available IVC filters. Methods and Results —The MEDLINE database was searched for all studies (1970-2014) related to IVC filters. A total of 88 clinical studies and 112 case reports qualified for analysis; these studies included 9002 patients and 15 types of IVC filters. Overall, penetration was reported in 19% of patients (1699/9002), and 19% of those penetrations (322/1699) showed evidence of organ/structure involvement. Among cases of penetration, 8% were symptomatic, 45% were asymptomatic, and 47% had unknown symptomatology. The most frequently reported symptom was pain (77%; 108/140). Major complications were reported in 83 patients (5%). These complications required interventions including surgical removal of the IVC filter (n=63), endovascular stent placement and/or embolization (n=11), endovascular retrieval of permanent filter (n=4), and percutaneous nephrostomy and/or ureteral stent placement (n=3). Complications led to death in 2 patients. A total of 87% (127/146) of patients underwent premature filter retrieval or interventions for underlying symptoms and/or penetration-related complications. Conclusions —Caval penetration is a frequent but clinically under-recognized complication of IVC filter placement. Symptomatic patients accounted for nearly one-tenth of all penetrations; most of these cases had organ/structure involvement. Interventions with endovascular retrieval and surgery were required in most of these symptomatic cases.