Robert Franklin Short MD, PhD., Presenter: Nothing to Disclose

Ulku Cenk Turba MD, Abstract Co-Author: Nothing to Disclose

Scott R. Geraghty MD, Abstract Co-Author: Nothing to Disclose

Bulent Arslan MD, Abstract Co-Author: Nothing to Disclose

Klaus D. Hagspiel MD, Abstract Co-Author: Grant, Siemens AG, Malvern, PA

Alan Hiyoshi Matsumoto MD, Abstract Co-Author: Speakers Bureau, W. L. Gore & Associates, Inc Speakers Bureau, Cook Group, Inc Speakers Bureau, Medtronic, Inc Advisory Board, Crux Biomedical, Inc Research grant, Talecris Biotherapeutics, Inc Research grant, Medtronic, Inc Research grant, W. L. Gore & Associates, Inc Research grant, Cook Group Incorporated Research grant, Siemens AG Consultant, Siemens AG Consultant, C. R. Bard, Inc Consultant, AGA Medical Corp Data Monitoring Safety Board, CH-Werfen

John F. Angle MD, Abstract Co-Author: Research grant, Atrium Medical Corporation Speaker, Siemens AG Consultant, AGA Medical Corp

et al, Abstract Co-Author: Nothing to Disclose

Retrievable inferior vena cava (IVC) filter utilization is expanding across patient populations, including in younger patients when benefit is thought to outweigh risk. We describe our institutional experience with retrievable IVC filters in pediatric patients and examine associated documentation practices.

A retrospective review of all IVC filter placements in patient under 18 years of age from 1997-2007 was conducted. Patient records including procedure dictations, discharge summaries, and follow-up clinic notes were reviewed for information related to the IVC filter including indication for placement, filter type, retrieval rates, and other possible related factors.

11 filters were placed in 10 pediatric patients (M = 2; F = 8; Age: mean = 16 +/- 1.4 yrs, range 14.6-17.8 yrs). 2 filters were placed following trauma; 9 were placed as prophylaxis in patients with symptomatic DVT undergoing catheter-based thrombolysis. 3/11 were suprarenal. One patient received a suprarenal filter for PE and thrombus cephalad to an infrarenal filter. All attempted retrievals were successful (n=8). Mean time to retrieval was 27 +/- 36 days (range 1-102 days). 27% of removable filters placed were not retrieved. Reasons included poor patient compliance with anticoagulation (n=1); time to thrombus resolution (125 days) for removal/embedded device (n=1); indeterminate (n=1). Angiography procedure reports impression indicated “removable/retrievable” filter in 6/11; 0/11 specified plans for removal. 8/11 filters were in place at discharge. Of these (n=8), clinical discharge summaries did not note IVC filter in 25%; erroneously identified the filter as “Greenfield” in 25%; and 75% did not specify plan for removal.

Retrievable IVC filters are a viable option for use in in adolescent patients when benefit exceeds risk; off label application of filters may be acceptable in older children when indicated. Care should be exercised to establish plans to ensure appropriate removal, particularly in this vulnerable population. .

Retirevable IVC filters can be used in adolescents when indicated, but care to establish removal plan must be emphasized as a significant proportion of filters may remain in place for life.

Short, R, Turba, U, Geraghty, S, Arslan, B, Hagspiel, K, Matsumoto, A, Angle, J, et al, , Utilization of Inferior Vena Cava Filters in Pediatric Patients: Clinical Success, Documentation Practices, and Retrieval Rates.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6011985.html