Guidelines for the Use of Retrievable and Convertible Vena Cava Filters: Report from the Society of Interventional Radiology Multidisciplinary Consensus Conference John A. Kaufman, MD, Thomas B. Kinney, MD, Michael B. Streiff, MD, Ronald F. Sing, DO, Mary C. Proctor, MS, Daniel Becker, MD, MPH, Mark Cipolle, MD, PhD, Anthony J. Comerota, MD, Steven F. Millward, MD, Frederick B. Rogers, MD, David Sacks, MD, and Anthony C. Venbrux, MD EDITOR’S NOTE: Endorsed by the American Venous Forum. J Vasc Interv Radiol 2006; 17:449 – 459 Abbreviations: DVT = deep vein thrombosis, IVC = inferior vena cava, PE = pulmonary embolism, VTE = venous thromboembolism RATIONALE FOR THE CONSENSUS CONFERENCE REMOVABLE vena cava filters for temporary protection from pulmonary embolism (PE) were first proposed in 1967 (1). In 2003 and 2004, the United States Food and Drug Administration approved changes to the instructions for use of three existing permanent fil- ters to allow percutaneous retrieval (2). Filter retrieval was added to the instructions without modification of the indications for placement or the addition of indications for retrieval. The instructions for use provide phy- sicians with minimal guidance for the use of these devices as removable fil- ters. Many medical specialties are in- volved in requesting and placing fil- ters as well as subsequent patient management. The overall use of vena cava filters may be increased by the availability of nonpermanent devices (3). However, there is a paucity of medical literature on these filters (4). On January 14 and 15, 2005, the Soci- ety of Interventional Radiology (SIR) convened a multidisciplinary confer- ence to address the clinical application of nonpermanent vena cava filters. Representatives from interventional radiology, trauma surgery, vascular surgery, and internal medicine partic- ipated. The goal of the consensus con- ference was to develop a document that would provide clinical guidance for all physicians who use these vena cava filters. Specifically, we sought to address the indications for placement of a nonpermanent filter, the manage- ment of patients with such a filter in situ, the conditions for discontinuation of caval filtration, the evaluation of patients before discontinuation, and patient management after discontinu- ation. Filter design, performance, re- porting standards, quality assurance, and recommendations for specific de- vice selection were not included in the discussions (5–7). PURPOSE OF THIS DOCUMENT The intent of this document is to provide suggestions for the clinical ap- plication of nonpermanent vena cava filters. These suggestions can be adapted to conform to local practices. More specifically, the document ad- dresses two types of optional filters available or about to become available From the Dotter Interventional Institute (J.A.K.), Or- egon Health & Science University, Mail Code L-605, 3181 Southwest Sam Jackson Park Road, Portland, Oregon 97239; Department of Radiology (T.B.K.), University of California San Diego Medical Center, San Diego, California; Department of Medicine (M.B.S.), Johns Hopkins University, Baltimore, Maryland; Department of Surgery (R.F.S.), Carolinas Medical Center, Charlotte, North Carolina; Depart- ment of Surgery (M.C.P.), University of Michigan Medical Center, Ann Arbor, Michigan; Department of Medicine (D.B.), University of Virginia Health Systems, Charlottesville, Virginia; Department of Surgery (M.C.), Lehigh Valley Hospital, Allentown; Department of Radiology (D.S.), The Reading Hos- pital, West Reading, Pennsylvania; Jobst Vascular Center (A.J.C.), Toledo, Ohio; Department of Sur- gery (F.B.R.), University of Vermont, Burlington, Vermont; Department of Radiology (A.C.V.), George Washington University Medical Center, Washington, DC; and Department of Radiology (S.F.M.), Peterborough Regional Health Center, Omemee, Ontario, Canada. Received December 17, 2005; accepted December 20. Address correspon- dence to J.A.K.; E-mail: kaufmajo@ohsu.edu Supported by unrestricted educational grants from anonymous corporate donor, CR Bard, Boston Scien- tific, Cook Group, Cordis Endovascular, and Terumo. This article will also appear in the March/April 2006 issue of Surgery for Obesity and Related Diseases and the World Journal of Surgery. J.A.K., T.B.K., R.F.S., and F.B.R. have identified a conflict of interest. © SIR, 2006 DOI: 10.1097/01.RVI.0000203418-39769.0D Special Communications 449