PATIENT OUTCOMES FOLLOWING PLACEMENT OF A 2ND INFERIOR VENA-CAVA FILTER - CASE-REPORTS

Inferior vena cava (IVC) interruption is being performed with increasi ng frequency. Indications for this procedure have expanded since the i ntroduction of percutaneous placement techniques. Indications for plac ement of a second IVC filter are less well defined. It has been report ed that a second filter can be placed safely. The purpose of this stud y was to investigate the intermediate and long-term follow-up of these patients. Five patients underwent placement of a second IVC filter at one institution from 1992 to 1996. During the same period a total of 439 patients underwent IVC filter placement. The five patients, rangin g in age from 46 to 67 years, included three men and two women. The in dication for the second filter placement was a confirmed or strongly s uspected recurrent pulmonary embolus (PIE), with thrombus in and above the previously placed IVC interruption device in all patients. Three of the five patients suffered from poorly controlled malignancies. One patient had an ependymoma of the spinal cord that was completely exci sed. The fifth patient had a documented hypercoagulable state: factor V resistance to activated protein C. The mean time between placement o f the first and second filters was 31 weeks (range: 1-65 weeks). Mean follow-up was 94 weeks (range: 0-252 weeks). One patient died within 2 4 hours of filter placement from profound hypoxemia from a preexistent PE. No fatal PE occurred in any of the four remaining patients. Two p atients in this study, following placement of a second IVC filter, had documented pulmonary emboli that were nonfatal. Two patients died as a result of their underlying malignancies. While placement of a second IVC interruption device is an infrequently performed procedure, it ap pears to be efficacious in preventing death from pulmonary emboli in t his extremely high-risk group of patients.