IVC Filters May Prevent Fatal Pulmonary Embolism in Musculoskeletal Tumor Surgery

To determine whether inferior vena cava (IVC) filter placement protects patients with musculoskeletal tumors from fatal pulmonary embolisms (PE), we retrospectively analyzed the records of 81 patients who underwent surgery for pelvic and lower extremity malignancies. All 81 patients received an IVC filter and mechanical compression for deep venous thrombosis (DVT) prophylaxis, but no pharmacologic anticoagulation. Duplex imaging was performed before hospital discharge and when clinical suspicion of DVT arose. Seventy-six of the 81 (94%) patients were followed at least 3 months (mean, 21.3 months; range, 3-77 months) postoperatively. We reviewed the perioperative medical records and office visit notes to determine the rate of clinically evident DVT, symptomatic PE, wound complications, and IVC filter-related complications. DVT and PE incidences in the early postoperative period (< 30 days) were 21% (17 of 81) and 2% (two of 81), respectively. There were no known deaths from PE. Patients undergoing reconstruction surgery (n = 41) were more likely to have early DVT develop after definitive tumor surgery. Patient age, tumor type or histology, anatomic location, presence of pathologic fracture, or development of wound complications did not correlate with an increased DVT rate. Two (3%) patients had late DVT, and none had a late PE. Combining an IVC filter with mechanical limb compression prevented fatal PE in patients undergoing orthopaedic surgery for malignancies of the pelvis and lower extremity and is a reasonable form of thromboembolic prophylaxis specific for this patient population. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.