Utilization Patterns with Inferior Vena Cava Filters: Surgical versus Percutaneous Placement

Purpose: To determine whether more inferior vena cava (IVC) filters were used after interventional radiologic placement methods became available, and if so, whether this increase could be due to expansion of indications. Patients and Methods: A retrospective analysis of the number of filters placed, the method of placement used, the indications for placement, and patient survival was performed during the 3 years before and the 3 years after 1989, the first year filters were placed percutaneously at the authors' institution. Results: From 1986 through 1988, 35 filters were all placed by surgeons in the operating room. From 1990 through 1992, 201 filters were all placed by radiologists in the special procedures suite. In the surgery group, 13 of 35 filters (37%) were placed for contraindications to anticoagulation therapy, 12 (34%) were placed for complications of anticoagulation, and nine (26%) were placed for recurrent thromboembolic disease despite anticoagulation. One filter was placed because of a free-floating thrombus in the IVC. In the radiology group, 98 of 161 patients (60%) underwent placement for contraindications to anticoagulation, 25 (16%) experienced complications of anticoagulation, 28 (17%) experienced recurrent thromboembolic disease, and nine (6%) had a free-floating thrombus. The 6-month survival in patients treated before 1989 was 80% versus 43% after 1989. Conclusion: At the authors' institution, filters are now placed exclusively by interventional radiologists. The overall indications for placement remain unchanged. The increase in utilization appears primarily related to more frequent placement in severely ill patients who may not experience considerably improved survival but may benefit from a substantial reduction in the risk of hemorrhagic complications.