Vena cava filters: Too often, too many, or just right

Venous thromboembolism (VTE) comprising both deep vein thrombosis (DVT) and pulmonary embolism (PE) is a common disease in the general population. The mainstay of the treatment for the most patients is anticoagulation. However, for patients who fail anticoagulation or are unable to receive anticoagulation because of a contraindication or increased risk of bleeding, inferior vena cava filters (IVCF) offer an attractive alternative for prevention of PE. Although beneficial in some patients, the utilization of IVCF has skyrocketed despite limited level I evidence. Much of this increase occurred after the introduction of optional (or retrievable) IVCF. Owing to low retrieval rates, so-called optional filters frequently become permanent, which may add to the morbidity associated with their routine use. In this review, we discuss various types of filters, their main indications, evidence behind their use, and the patterns of utilization.