Role of vena cava filters in high-risk trauma and elective orthopaedic procedures

Pulmonary embolism (PE) is the leading cause of death after trauma and is the most common cause of death in the immediate post-operative period after lower limb reconstructive procedures. Although, systemic anticoagulation is the corner stone of both prophylaxis and treatment of venous thromboembolism, there is increasing awareness and usage of vena caval filters (VCFs) in high-risk patients. Instead of permanent filters, retrievable filters are predominantly used nowadays by interventional radiologists aiming to avoid long-term complications such as inferior vena caval obstruction and post-phlebitic syndrome. It is evident from the available literature that prophylactic filters do protect against fatal PE in high-risk trauma and patients undergoing complex lower limb reconstructive procedures; however, there is uncertainty about the efficacy of different types of filter designs and clear indications of the high-risk group remain controversial.