SIR 2024
Venous Interventions
Mina Dawod, B.S.
Medical Student
The Ohio State University College of Medicine
Disclosure information not submitted.
Mensur Koso, BS
Medical Student
The Ohio State University College of Medicine
Disclosure information not submitted.
Matthew Yoder, BS
Medical Student
The Ohio State University College of Medicine
Disclosure information not submitted.
Mina S. Makary, MD (he/him/his)
Interventional Radiologist
The Ohio State University Wexner Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
This study evaluated the outcomes of orthopedic surgery patients who were protected against pulmonary embolism (PE) with inferior vena cava (IVC) filters.
Materials and methods:
This IRB-approved, single-center retrospective study evaluated patients undergoing orthopedic surgery who were prophylactically protected with IVC filters from January 2007 to December 2021. Patient demographic and clinical characteristics, surgical and interventional details, and post-placement clinical outcomes were analyzed. Study outcomes include incidence of venous thromboembolism (VTE) in the form of deep vein thrombosis (DVT) and PE. VTE occurrence was monitored from filter placement to filter retrieval, or until the present in the absence of any retrievals. Complications related to filter placement and retrieval were also tracked. A multivariate statistical analysis was performed to uncover any significant correlations.
Results:
A total of 104 patients (median age, 57; female 53%/male 47%) undergoing orthopedic surgery were prophylactically protected against PE with IVC filters. This cohort was surgically diverse with 50 patients (48%) having underwent arthroplasty, 17 (16%) underwent amputations, disarticulations, and hemipelvectomies, 16 (15%) had resections and an equal number (n=16) had open reduction and internal fixations (ORIF), three patients (3%) underwent incision and drainages (I&D), and two patients (2%) had complex multi-operational surgeries. Patients were high-risk given the large burden of comorbidities, including low functional status (87%), VTE history (62%), malignancy (57%), and history of tobacco use (47%). All IVC filters were placed without complication with an average procedure duration of 16.6 minutes. A majority of IVC filters were removed (58%; n=60), with an average dwell time of 6.7 months (1-31 months). Three removal attempts encountered difficulty that led to aborted attempts of which two were later successful and one was unsuccessful due to filter malalignment. No other filter complications were encountered. In the post-placement period, a total of 16 patients (15%) experienced DVTs with four patients (4%) experiencing definitive PEs. There were 9 thrombi and thrombotic burdens that were found at the level of the filter or near it.
Conclusion:
IVC filters were placed and retrieved in orthopedic surgery patients with a low complication rate while achieving a low incidence of VTE in this high-risk cohort with a majority of filters being removed.