We talk with interventional radiologist Dr. Stephen Wang about building an IVC filter retrieval program, the current guidelines on filter placement, and how to minimize the complications of filters.
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SHOW NOTES
In this episode, host Dr. Christopher Beck interviews interventional radiologist Dr. Stephen Wang. They discuss building an IVC filter retrieval program, the current guidelines on filter placement, and the long-term risks of IVC filters.
We start by discussing the joint consensus published in JVIR in 2020, a collaboration between vascular, cardiology, and IR societies. Dr. Wang notes that the main indication for placement of an IVC filter is an acute deep venous thrombosis (DVT) or pulmonary embolism (PE) in someone with a contraindication to anticoagulation. He says that they often collaborate with hematology to provide the best patient care, and they have even collaborated with hematology to set up a filter clinic.
Next, they touch on the long-term risks of IVC filters. They discuss the PREPIC-1 and PREPIC-2 studies which were studies looking at mortality and risk reduction in patients with IVC filters. These studies demonstrated a low level of evidence that IVC filters being placed were actually working. Even more compelling, the risk of putting in filters often outweighs the benefit. Dr. Wang says that for a filter that is in for longer than five years, there is a 13% risk of partial or complete inferior vena cava (IVC) thrombosis. Additionally, at five years, 70% of filters perforated outside of the IVC and were touching or perforating a retroperitoneal structure.
Finally, they discuss the filter retrieval program that Dr. Wang built at Kaiser. Important aspects of the process were educating primary care doctors, coordinating with critical care and hematology, and involving the anticoagulation clinic. He says he created a current procedural terminology (CPT) code-based list and hired a physician extender as filter lead to monitor and update the list. He was able to get his EPIC team on board by creating a safety net based on a procedural code. Ultimately, he raised the IVC filter retrieval rate from 38% in Northern California to 54% after his grand rounds and up to 80% after integrating his program into EPIC which allowed a provider to click a single button that would notify the patient that they were due to come in for their IVC filter retrieval.
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RESOURCES
SIR Clinical Practice Guidelines for IVC Filters:
https://www.jvir.org/article/S1051-0443(20)30531-5/fulltext
PREPIC-1:
https://www.nejm.org/doi/full/10.1056/NEJM199802123380701
PREPIC-2:
https://jamanetwork.com/journals/jama/fullarticle/2279714
Dr. Wang’s paper: Long-term complications of inferior vena cava filters:
https://www.jvsvenous.org/article/S2213-333X(16)30148-2/fulltext
