Quantitative imaging in medicine and surgery · 2025
Optimizing the management strategy for inferior vena cava filter.
СтатьяНазвание и аннотация: Перевод в очереди
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Guillaubey Geoffroy, Ayoub Elie, Grange Rémi, Poenou Géraldine, Cixous Pierre, Boutet Claire, Bertoletti Laurent, Grange Sylvain
Аннотация
BACKGROUND: Complications related to the inferior vena cava filter (IVCF) increase with prolonged dwell time. We therefore evaluated the efficacy of two new methods of monitoring patients in terms of retrieval rates, and compared them with our previous practice, which did not involve a multidisciplinary (MD) approach.
METHODS: From April 1st, 2012 to October 31st, 2019, patients were monitored by the vascular medicine department, without MD follow-up. From November 1st, 2019 to October 31st, 2021, a letter was sent to the patients' general practitioner (GP) to inform them of the need for a specialist consultation to assess whether the filter was still indicated. From November 1st, 2021 to November 1st, 2023, an MD discussion was organised between the radiologist and the vascular physician to assess the indication for retrieval. This discussion systematically reviewed the evolution of the contraindication to anticoagulant therapy (AT), the initial indication for filter implantation, and the patient's life expectancy. If retrieval was considered appropriate, the patient was contacted and scheduled for the removal procedure. The retrieval rates of the different methods and the occurrence of complications were measured in each group and compared.
RESULTS: The overall retrieval rate of IVCFs increased, though not significantly (P=0.15), from 40.5% with no specific follow-up (NSF), to 42.4% when a letter was sent to the GP, and to 49.7% when an MD meeting was implemented. In contrast, the adjusted retrieval rate improved significantly (P<0.001), rising from 62.9% with NSF, to 69.7% with a GP's letter, and reaching 97.5% following an MD meeting.
CONCLUSIONS: MD involvement in patient follow-up leads to a significant improvement in the removal of IVCF that are no longer clinically necessary. Sending a letter to the GP is effective, but MD follow-up is more effective.
METHODS: From April 1st, 2012 to October 31st, 2019, patients were monitored by the vascular medicine department, without MD follow-up. From November 1st, 2019 to October 31st, 2021, a letter was sent to the patients' general practitioner (GP) to inform them of the need for a specialist consultation to assess whether the filter was still indicated. From November 1st, 2021 to November 1st, 2023, an MD discussion was organised between the radiologist and the vascular physician to assess the indication for retrieval. This discussion systematically reviewed the evolution of the contraindication to anticoagulant therapy (AT), the initial indication for filter implantation, and the patient's life expectancy. If retrieval was considered appropriate, the patient was contacted and scheduled for the removal procedure. The retrieval rates of the different methods and the occurrence of complications were measured in each group and compared.
RESULTS: The overall retrieval rate of IVCFs increased, though not significantly (P=0.15), from 40.5% with no specific follow-up (NSF), to 42.4% when a letter was sent to the GP, and to 49.7% when an MD meeting was implemented. In contrast, the adjusted retrieval rate improved significantly (P<0.001), rising from 62.9% with NSF, to 69.7% with a GP's letter, and reaching 97.5% following an MD meeting.
CONCLUSIONS: MD involvement in patient follow-up leads to a significant improvement in the removal of IVCF that are no longer clinically necessary. Sending a letter to the GP is effective, but MD follow-up is more effective.