5-YEAR FOLLOW-UP OF PROPHYLACTIC VENA-CAVA FILTERS IN HIGH-RISK TRAUMA PATIENTS

Objective: To assess the short-and long-term outcomes of vena cava fil ter (VCF) placement for prophylaxis against pulmonary embolism in pati ents at high risk due to trauma. Design and Setting: Case series at a level I trauma center. Patients: Patients were considered for prophyla ctic VCF placement if they met 1 of the injury criteria-spinal cord in juries with neurologic deficit, severe fractures of the pelvis or long bone (or both), and severe head injury-and had a contraindication to anticoagulation. Intervention: Vena cava filters were placed percutane ously by the interventional radiologists when the acute trauma conditi on was stabilized following admission. Main Outcome Measures: Filter t ilt of 14 degrees or more, strut malposition, insertion-related deep v ein thrombosis, pulmonary embolism, or inferior vena cava patency. Res ults: There were 132 prophylactic VCFs placed. A 3.1%, rate of inserti on-related deep vein thrombosis occurred, all of which were asymptomat ic. Filter tilt occurred in 5.5% of patients and strut malposition in 38%. Three cases of pulmonary embolism (1 fatal) occurred in a prophyl actic VCF, and all patients had either filter tilt or strut malpositio n. The risk of pulmonary embolism developing was higher in those patie nts with filter tilt or strut malposition than in those who did not ha ve these complications (6.3%, vs 0%; P=.05; Fisher exact test). The 1- , 2-, and 3-year inferior vena cava patency rates (+/-SD) were 97%+/-3 %. Conclusions: Prophylactic VCF can be placed safely with an acceptab le rate of insertion-related deep vein thrombosis and long-term inferi or vena cava patency. Patients with prophylactic VCF remain at risk fo r pulmonary embolism if the filter is tilted 14 degrees or more or has strut malposition. In such patients, consideration should be given to placing a second filter.