September 9, 2020 — The Society of Interventional Radiology (SIR) published new clinical practice guidelines that provide evidence-based recommendations on the use of inferior vena cava (IVC) filters to treat venous thromboembolism (VTE).
“These guidelines allow physicians treating patients at risk of a pulmonary embolism to make evidence-based decisions about the use of IVC filters,” said John A. Kaufman, M.D., MS, FSIR, the guidelines’ primary author and chair of the department of interventional radiology at Oregon Health and Science University in Portland. “Throughout the process, the multidisciplinary team followed a gold-standard methodology to ensure we reached the best possible consensus on VTE patient care.”
The guidelines advise against the routine placement of IVC filters in most VTE cases where patients are being successfully treated with anticoagulants. However, if anticoagulation therapies fail or are not indicated for the patient, IVC filters may be considered as a treatment option if clinical risk factors such as bleeding, vascular injury, device migration and increased risk of recurrent deep vein thrombosis (DVT) are considered and deemed low.
When IVC filters are placed, the guidelines recommend a follow-up program to increase retrieval and detect complications. In addition, if patients with retrievable IVC filters are no longer at risk of developing a pulmonary embolism (PE), the guidelines recommend removal unless the risk outweighs the benefits.
“With these multidisciplinary guidelines, the authors have removed any inconsistencies and uncertainties older guidelines may have presented physicians treating patients with VTE,” said SIR President Michael D. Dake, M.D., FSIR, senior vice president of the University of Arizona Health Sciences in Tucson. “The authors should be proud of this achievement.”
This is SIR's first official clinical practice guideline, developed using gold-standard guideline methodology following the Standards for Trustworthy Clinical Practice Guidelines set by the National Academy of Medicine. SIR is committed to continuing developing evidence-based clinical practice guidelines to optimize patient care and improve patient outcomes.
Recommendation sections of the document with level of evidence noted include:
• Acute PE
• Acute DVT
• Anticoagulation for VTE
• Recurrent VTE
• Trauma Patients without Known VTE
• Routine IVC Filter Placement PE with Advanced Therapies
• DVT with Advanced Therapies
• Major Surgery Patients without Known VTE
• Indwelling IVC Filters with No Anticoagulation Indication
• Indwelling IVC Filters with Mitigated PE Risk
• Complications and Indwelling IVC Filters
• Structured Follow-up
• Planned Filter Removal
• Filter Removal without Standard Snare Techniques
• Filter Placement Technique
The guidelines were developed in collaboration with and endorsed by the American College of Cardiology (ACC), the American Heart Association/American Stroke Association, American College of Surgeons (Committee on Trauma), American College of Chest Physicians (CHEST), Society for Vascular Medicine, Society for Vascular Surgery. The Canadian Association for Interventional Radiology and Cardiovascular and Interventional Radiological Society of Europe have also endorsed the guidelines. The American Society of Hematology has affirmed the value of the statement.
About the Society of Interventional Radiology
The Society of Interventional Radiology (SIR) is a nonprofit, professional medical society representing more than 8,000 practicing interventional radiology physicians, trainees, students, scientists and clinical associates, dedicated to improving patient care through the limitless potential of image-guided therapies. SIR’s members work in a variety of settings and at different professional levels—from medical students and residents to university faculty and private practice physicians. Visit sirweb.org.
1. John A. Kaufman, Geoffrey D. Barnes, Rabih A. Chaer, et al. Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease. Journal of Vascular and Interventional Radiology. Article in press. Published online September 8, 2020. DOI:https://doi.org/10.1016/j.jvir.2020.06.014