Inferior vena cava interruption: how and when?

Interruption of the inferior vena cava (IVC) to prevent pulmonary embolism arising from venous thrombi in the lower extremities has become widely used since IVC filters became available about 30 years ago. However, reliable data regarding efficacy and safety of IVC filters are still lacking. The first controlled clinical trial of IVC filters demonstrated their effectiveness, but filters had no detectable impact on mortality and were associated with an increased risk of recurrent deep venous thrombosis. On the basis of the literature, indications for IVC interruption can be classified as accepted, debated, and debatable. The relevance of debated indications, more accurate identification of patients who remain "very high-risk" despite preventive or curative anticoagulant treatment, and selection of the most appropriate filter should be looked at in prospective clinical studies.