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Online ISSN 1827-1847
ENDOVENOUS TREATMENT OF VARICOSE VEINS
Naddaf A., Avgerinos E. D., Chaer R. A.
Division of Vascular Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
Venous thromboembolism (VTE) is a major cause of morbidity and mortality. Vena cava filters (VCFs) have been successful in patients with proven VTE in whom pharmacologic prophylaxis is contraindicated. However, in the past two decades, especially with the introduction of the retrievable VCF, placement of such devices has widely expanded predominately for prophylactic indications. With different expert bodies supporting opposing recommendations, the practice has seen diverging patterns of VCF use as the lack of solid studies makes clear-cut evidence recommendations unavailable. While several recent meta-analyses have been able to resolve burning questions for certain patient populations, it remains difficult to set clear protocols for the prophylactic use of VCFs. It also remains true that physicians will have to conduct a rigorous risk/benefit analysis before placing VCFs, due to the several technical and follow-up concerns regarding their use. The current review summarizes contemporary evidence and indications for VCF placement and updates on issues surrounding the use of retrievable filters, including retrieval concerns and long term management of these patients.