OTA 2006 Posters

Scientific Poster #59 Pelvis

Prevention of Pulmonary Embolus with Inferior Vena Cava Filters in the Presence of Deep Vein Thrombosis in Patients with Acetabular and Pelvic Fractures
Jose B. Toro, MD (n); Christian Hierholzer, MD (n); Domenico Sama, MD (n); Cagri Kosi, MD (n); William Ertl, MD (n); David Helfet, MD (n)

Purpose: The present study was designed to evaluate late clinical complications after the placement of non-removable Inferior Vena Cava (IVC) filters as a prophylactic measure for pulmonary embolus (PE) in patients with a diagnosis of an acetabular and/or pelvic fracture and a positive screening for DVT or PE.

Methods: Between 1991 to 2003, 102 consecutive patients, available for follow-up, were identified with a pelvic and/or acetabular fracture and a positive preoperative screening for DVT/PE who were treated with IVC filter as a prophylactic measure.

Of the 102 patients analyzed, 5 were treated non-operatively and 97 were treated with open reduction and internal fixation (ORIF). All patients were treated by a single surgeon and managed with IVC filter as a treatment for prevention of pulmonary embolism as part of a strict DVT/PE protocol.

Complications were evaluated, by two methods: (i) systematic medical record information review for IVC filter complications for each clinic visit and (ii) a mailed questionnaire.

Results: Of the 102 patients, eighty-eight (86%) patients returned the questionnaire. Average follow-up time was 3.95 years. From this subset, no patients reported hospital re-admission for a recurrence of deep vein thrombosis or PE. Seven percent (6/88) of patients described new lower extremity swelling, 13% (12/88) patients noted chronic use of blood thinners (reasons related to Coronary Artery Disease). One patient reported chronic use of coumadin as anticoagulation treatment for management of sequalae related to PE developed secondary to the pelvic fracture before the placement of the IVC filter and an additional patient reported clear fluid as weeping drainage from the extremities.
No late complications were found related to the IVC filter such as death, migration, IVC clot formation or clinical evidence on new cases of PE or DVT.

Conclusion and Significance: In our study the use of Inferior Vena Cava filters was a safe clinical procedure in trauma patients with acetabular and pelvic fractures with a positive screening for DVT/PE preoperatively an with a contraindication for medical treatment.

Based on this small series, the use of non-removable IVC filters for PE prophylaxis, in patients with acute pelvic and acetabular fractures with documented proximal DVT and PE appears both safe and efficacious.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.