We read with great interest the article by Grubman et al1 regarding the association between the placement position of inferior vena cava filters (IVCFs) and the incidence of device-related complications.
The past half-century has seen the topic of IVCFs rushed into the forefront of public attention; yet many controversies regarding their utilization and net benefit remain.2, 3, 4 Over the years, researchers have strived to identify risk factors associated with complications arising from IVCF placement, aiming to mitigate these risks for patients and improve the safety of IVCF use.2,3 However, the effect of IVCF position on device complications remains not well-elucidated. Grubman et al1 conducted a study involving 1230 patients who received IVCFs and found that short-term and long-term complications, such as IVC thrombosis, are rare. Notably, the placement position relative to the renal veins did not significantly impact the outcomes in this study. These findings address a crucial gap in the current literature, particularly in the ongoing debate surrounding the optimal placement of IVCFs.
In their article, Grubman et al1 identified the renal veins using IVC venography. The measurement of IVCF position was assessed by determining the distances from the IVCF tip to the inferior margin of the most caudal renal vein. We believe that IVC venography might underestimate or overestimate the true lowest wall of the renal vein due to factors such as bowel gas, respiration, obesity, and even the presence of the angiographic catheter, potentially impacting the grouping. Nevertheless, there remains a lack of consensus on the most effective diagnostic modality. Utilizing IVC computed tomography venography to overcome these inherent limitations may offer valuable insights. Additionally, a minor discrepancy was observed in Fig 2, where the number of excluded patients can be corrected to 267 (n = 17.8%). However, this adjustment does not alter the final conclusions drawn from this study.
We therefore propose that future research focus on optimizing the measurement protocols or conducting comparative studies using different measurement methods to yield more accurate results. Such endeavors would augment our comprehension of IVCF positioning and its correlation with complications in patients, ultimately enhancing patient care.
References
- 1.Grubman S., Kostiuk V., Brahmandam A., et al. Effect of inferior vena cava filter placement position on device complications. J Vasc Surg Venous Lymphat Disord. 2023;11:1165–1174.e2. doi: 10.1016/j.jvsv.2023.05.020. [DOI] [PubMed] [Google Scholar]
- 2.Warren R.E., Dhruva S.S., Kinard M., Neuhaus J.M., Redberg R.F. Trends in FDA adverse events reporting for inferior vena cava filters and estimated insertions in the US, 2016 to 2020. JAMA Intern Med. 2023;183:271–272. doi: 10.1001/jamainternmed.2022.6161. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Zhang F., Gu J., Li H.L., China Venous Thromboembolism and Inferior Vena Cava Filter Clinical Application Cooperation Group Diagnosis and treatment of venous thromboembolism and clinical application of inferior vena cava filter in China. J Vasc Surg Venous Lymphat Disord. 2023;11:1149–1156. doi: 10.1016/j.jvsv.2023.05.003. [DOI] [PubMed] [Google Scholar]
- 4.Kesselman A., Oo T.H., Johnson M., Stecker M.S., Kaufman J., Trost D. Current controversies in inferior vena cava filter placement: AJR expert panel narrative review. AJR Am J Roentgenol. 2021;216:563–569. doi: 10.2214/AJR.20.24817. [DOI] [PubMed] [Google Scholar]