Study Design: Clinical case series.
Objective: To show the efficacy of prophylactic inferior vena cava (IVC) filters in preventing venous thromboembolic event (VTE) in high-risk patients undergoing major spinal surgery.
Summary of Background Data: Patients undergoing major spinal surgery are at increased risk for VTEs. Recent studies have shown IVC filters are effective in preventing clinically significant pulmonary embolism (PE), but have not documented the frequency of all emboli prevented.
Methods: Patients undergoing major spinal surgery from 2006 to 2009, having IVC filters placed for VTE prophylaxis, were reviewed. Patients with 2 or more risk factors for VTE were included and their perioperative courses were reviewed for PE and device-related complications. Cavograms obtained at the time of attempted filter retrieval identified intercepted emboli. The rates of intercepted emboli and clinical PEs were compared with those of similar populations undergoing similar procedures.
Results: Approximately 17% of patients had entrapped thrombus present at attempted filter retrieval. An additional 17% of filters were unable to be retrieved due to change in position within the IVC. No patients experienced symptomatic PE. One patient developed a deep vein thrombus requiring pharmacologic treatment and another patient developed superficial phlebitis. There were no complications related to IVC filter use.
Conclusions: These findings show that the decreased rate of PE observed in this and other series is likely because of the use of IVC filters, rather than sampling bias inherent when studying a relatively rare problem. The safety of IVC filters in this population is also confirmed. The observed rate of clinical PE is consistent with other published series. Emboli intercepted by filters may more accurately estimate clinically significant emboli prevented. Therefore, cavograms may prove to be a valuable method of assessing the efficacy of these devices in future studies.
*Department of Orthopaedics, Stony Brook University Hospital
†Division of Thoracic & Cardiovascular Surgery, Winthrop University Hospital
‡State University of New York at Stony Brook School of Medicine
§Department of Neurological Surgery, PC
∥New York Spine and Scoliosis Center, NY
Marc A. Agulnick is a consultant for Stryker. The other author declares no conflict of interest.
Reprints: Ryan M. Vellinga, BS, 20 Rainbow Dr, Hauppauge, NY 11788 (e-mail: firstname.lastname@example.org).
Received October 11, 2010
Accepted February 10, 2011