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Caval filters in intensive care: a retrospective study

Authors Ferraro F, Di Gennaro TL, Torino A, Petruzzi J, d'Elia A, Fusco P, Marfella R, Lettieri B

Received 20 May 2014

Accepted for publication 20 June 2014

Published 6 November 2014 Volume 2014:8 Pages 2213—2219


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Video abstract presented by F Ferraro.

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F Ferraro,1 TL Di Gennaro,1 A Torino,1 J Petruzzi,1 A d’Elia,1 P Fusco,1 R Marfella,2 B Lettieri1

1Department of Anesthesiological, Surgical and Emergency Sciences, 2Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy

Aim: To evaluate the effectiveness of a caval vein filter (CVF) peri-implant monitoring protocol in order to reduce pulmonary embolism (PE) mortality and CVF-related morbidity.
Background: The reduction in mortality from PE associated with the use of CVF is affected by the risk of increase in morbidity. Therefore, CVF implant is a challenging prophylactic or therapeutic option. Nowadays, we have many different devices whose rational use, by applying a strict peri-implant monitoring protocol, could be safe and effective.
Materials and methods: We retrospectively studied 62 patients of a general Intensive Care Unit (ICU) scheduled for definitive, temporary, or optional bedside CVF implant. A peri-implant monitoring protocol including a phlebocavography, an echo-Doppler examination, and coagulation tests was adopted.
Results: In our study, no thromboembolic recurrence was registered. We implanted 48 retrievable and only 20 definitive CVFs. Endothelial adhesion (18%), residual clot (5%), cranial or caudal migration (6%), microbial colonization of the filter in the absence of clinical signs of infection (1%), caval thrombosis (1%), and pneumothorax (1%) were reported. Deep-vein thrombosis (DVT) was reported (8%) as early complication. All patients with DVT had a temporary or optional filter implanted. However, in our cohort, definitive CVFs were reserved only to 32% of patients and they were not associated with DVT as complication.
Conclusion: CVF significantly reduces iatrogenic PE without affecting mortality. Generally, ICU patients have a transitory thromboembolic risk, and so the temporary CVF has been proved to be a first-line option to our cohort. A careful monitoring may contribute to a satisfactory outcome in order to promote CVF implant as a safe prophylaxis option.

Keywords: caval vein filter, thromboembolic disease, pulmonary embolism

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