A Georgia medical malpractice jury returned its verdict on December 20, 2023 in favor of the plaintiff in the amount of $3.2 million and an additional $308,000 in favor of the plaintiff’s wife for the serious harm suffered by the husband as a result of alleged negligent inferior vena cava (IVC) filter surgery two weeks before he was scheduled to have gastric bypass surgery.
According to the plaintiff, the hospital where the IVC filter placement was performed on November 3, 2016 used the wrong equipment during the procedure, which did not permit the doctor to see what he needed to see. The plaintiff further alleged that the hospital failed to follow the manufacturer’s operating instructions and warning for the machine used in an attempt to remove the filter, which resulted in the machine’s failure: “The defense attempted to blame everybody. The surgeon, the machine itself, the patient, they wanted to blame everybody and not acknowledge it was their machine, it broke and we contend they had responsibility for that.”
The plaintiff needed a stay in the ICU overnight after which a third attempt to remove the IVC filter was successful. The plaintiff incurred $650,000 in medical bills as a result of his more than two months inpatient stay in the hospital, including more than $440,000 in medical bills from the defendant hospital. The plaintiff alleged that he continues to suffer with long-term heath issues resulting from his hospital ordeal.
The plaintiff’s Georgia medical malpractice attorney stated after the verdict, “He is now permanently disabled because of that injury that has hampered him to do pretty much anything. He is an extremely deserving client, he has maintained a very positive attitude despite the challenges he has undergone and has been patient through this process.”
IVC Filter
Pulmonary embolism (PE) secondary to venous thromboembolism (VTE) is a major preventable cause of mortality in hospitalized patients. Prophylactic anticoagulation with mechanical and pharmacological therapies is indicated for high-risk patients. Pharmacological anticoagulation is the first-line treatment for newly diagnosed VTE and pulmonary embolism. Inferior vena cava (IVC) filter is a treatment option to prevent pulmonary embolism in a select group of patients that have venous thromboembolism (VTE) and absolute contraindication to anticoagulation, failure of anticoagulation, complications resulting from anticoagulation or progression of deep vein thrombosis (DVT) despite adequate anticoagulation.
The Greenfield inferior vena cava filter came on the market in 1973. Currently, there are two categories of IVC filters in use: permanent and retrievable. The use of IVC filters has increased since the advent of retrievable IVC filters that were approved by the FDA in 2003 and 2004.
Most studies have not shown any difference in the all-cause mortality in deep venous thrombosis (DVT) patients treated with IVC filters compared to the ones treated with anticoagulation therapy alone. Prophylactic IVC filters are sometimes inserted in patients at high risk of developing venous thromboembolism (VTE), especially if there is a contraindication to anticoagulation. These studies have not shown any mortality benefit. In fact, IVC filters correlate with an increased risk of recurrent deep vein thrombosis and other complications.
In clinical practice, clinicians sometimes use IVC filters prophylactically in patients at high risk of venous thromboembolism (VTE). These include patients with long term immobilization (e.g., secondary to extensive trauma and surgical procedures) and certain medical conditions that induce a hypercoagulable state (e.g., cancer). A randomized controlled trial compared two groups of patients presumed to be at high risk for DVT; one group received a permanent IVC filter and the other low-molecular-weight heparin with adjusted dose IV heparin. The group that received a permanent IVC filter initially showed a reduced incidence of pulmonary embolism, but there were no immediate or long term differences in mortality. After a follow-up of two years, the incidence of recurrent DVT in the IVC filter group was significantly higher.
Inferior vena cava filter insertion is generally considered safe. There are no known absolute contraindications to IVC filter placement; some relative contraindications to IVC filter use include severe uncorrectable coagulopathy and bacteremia.
IVC Filter Insertion
After sterile preparation of the access site, a small incision is made, and a catheter is inserted, ideally under fluoroscopic guidance. The filter is then pushed along the catheter and deployed. The most common location for IVC filter placement is just inferior to the inflow of the renal veins. This site is preferable due to the minimal risk of thrombus occluding the renal veins. The IVC filter can be placed in the suprarenal IVC in some instances like pregnancy, thrombus in the infrarenal location, and other conditions in which IVC filter placement in the infrarenal location is not feasible.
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