Discussion Author(s): Primary author: Jason Messinger
Contributing author: Eric Jones
In patients with renal vein or suprarenal IVC clots, intervention by suprarenal IVC filter placement becomes necessary to prevent PE. Suprarenal IVC filter intervention is significantly more challenging than infrarenal IVC filter placement due to safety concerns related to placement (Kaval, et al.). Additionally, most IVC filters provide instruction solely on infrarenal placement (Kaval, et al.).
Greenfield, et. al, concluded the efficacy of suprarenal IVC filter intervention based on twenty-five years of clinical usage. Kalva, et al. demonstrated the successful application of suprarenal IVC filter placement in preventing further IVC thrombus migration. Kalva et al. also concluded that infrarenal and suprarenal filters have comparable efficacies. Use of suprarenal IVC filter was successful in preventing PE in patients with renal and IVC thrombi (Abujudeh et al.).
Suprarenal IVC filters do have some associated risks such as acute renal failure, however this occurrence is rare (Janvier et al.) Despite the results of the Janvier et al. study, a majority of reports conclude that suprarenal IVC filters are safe with unremarkable lasting effects on renal function once deployed (Matchett et. al).
The use of suprarenal IVC filters is an option that should be considered in appropriate patients. The increased risk in placing suprarenal IVC filters does not outweigh the successes of preventing PE as indicated by numerous studies.
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