Indwelling inferior vena cava (IVC) filters can cause complications including penetration into surrounding structures, migration, and thrombosis of the vena cava. Computational fluid dynamics suggests juxtarenal placement of IVC filters decreases the risk of thrombosis, however this has not been explored clinically. This study examines the impact of filter placement position on long-term device complications with an emphasis on IVC thrombosis. We hypothesized that IVC filters placed further caudal to the renal veins were more likely to develop long-term thrombosis.
A retrospective chart review of patients receiving IVC filters at a single tertiary center between 2008 and 2016 was performed. Patients missing follow-up or procedural imaging were excluded. Placement procedure venograms were reviewed and the distance from filter apex to the more inferior renal vein was measured using published IVC filter lengths for calibration. Patients were divided into 3 groups by tip position relative to the more inferior renal vein: at or superior (Group A), 1-20mm inferior (Group B), and >20mm inferior (Group C). Patient characteristics, procedural characteristics, and outcomes were compared between groups. The primary endpoints were IVC thrombosis and device-related mortality.
Of 1,497 eligible patients, 267 (17.8%) were excluded. The most common placement position was Group B (64.0%). Mean age was lowest in Group C vs. A or B (59.5 vs. 64.6, 62.2, p=0.003). There were no statistically significant differences in sex or measured comorbidities. Group C were the most likely to have jugular access (71.7% vs. 48.3%, 62.4%, p<0.001) and received more first-generation filters (58.5% vs. 46.6%, 52.5%, p=0.045). Short- (<30-day) and long-term (≥30-day) outcomes including access site hematoma DVT and PE were uncommon with no difference between the groups. Instances of symptomatic filter penetration, migration, and fracture were rare (1, 1, and 3 instances respectively). While there was a pattern of increasing thrombosis with more inferior placement, the difference between groups was not significant (A=1.5%, B=1.8%, and C=2.5%, p=0.638). There were no cases of device-related mortality. All-cause mortality after a mean follow-up of 2.6 (±2.3) years was 41.3% and did not significantly vary between groups (p=0.051). Multivariate logistic regression found placement position did not predict short- or long-term DVT and PE, IVC thrombosis, or all-cause mortality after adjustment for patient baseline characteristics.
IVC filters have low rates of short- and long-term complications including IVC thrombosis. Placement position did not impact device complications in this study.

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