Complications Associated with Inferior Vena Caval Filter Insertion
The earliest mechanical approaches to prevent pulmonary thromboembolism were associated with signiﬁcant complications when the techniques were limited to direct operative approaches to the vena cava for ligation, placation or external clip application. When endovascular techniques were developed for vena caval ﬁlter placement more than 30 years ago, morbidity was reduced signiﬁcantly, since venous access could be achieved under local anesthesia. But a more signiﬁcant change occurred in the 1980s, when percutaneous sheaths and dilators converted the procedure from surgical to radiological. With this change, a variety of innovative ﬁlters emerged, characterized by relative ease of insertion and smaller proﬁle to minimize the size of the sheath for introduction. The focus of complications had shifted from the procedure to the actual placement and performance of the ﬁlter. Unfortunately, most efforts in recent years have been to further reduce the proﬁle of the carrier systems, so current publications found in the radiological journals have more to do with techniques and ease of insertion than evaluation of device performance over time. In fact, there is very little information about the long-term performance and complications of most of the vena caval ﬁlters used today.