The importance of the vena cava filter in the treatment of deep iliacal orlower extremity vein thrombosis

The indication of vena cava filter implantation is controversially discusse d. A pure prophylactic indication is increasingly favoured, especially for temporary filter systems without any anamnestic pulmonary embolisms. On the basis of the available literature and our own results a critical analysis of this issue is given. Between 1994 and 1997, we inserted a total of 24 ve na cava filters; 21 temporary and 3 permanent filters. In ten patients, the placement of the filter was indicated due to pulmonary embolism and a cont ra-indication to dose adjusted heparin therapy. Seven additional patients e xperienced a recurrent pulmonary embolism despite adequate heparin therapy. A prophylactic filter insertion was carried out in seven patients. The tem porary vena cava filters were left in place between 7 to 38 days with an av erage of 19 days. Total implantation time of temporary filters was schedule d until complete mobilisation of the patients, generally in conjunction wit h an effective dosage of oral anticoagulants. No patient died in connection with the insertion of the filter and no further pulmonary embolisms occurr ed. One case of inferior vena cava thrombosis occurred in each group of tem porary and permanent filters. In one third of the removed filter systems th rombi in the filter were found. Local infections of the catheter and introd ucer sets were observed in two patients. Moreover, in one case the strut of a temporary filter broke and subsequently dislocated 17 days after inserti on. We conclude on the basis of these complication rates that until the res ults of randomised studies are available the usage of all filter systems sh ould be limited to highly selected cases.