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Placement of inferior vena cava (IVC) filters without subsequent retrieval is responsible for the worrisome rise of IVC thrombosis, clinicians say.

IVC thrombosis is estimated to account for 2.6% to 4.0% of deep venous thrombosis cases, although "the true incidence of due to the lack of standardized methods of its detection and reporting, as well as the exponential increase in the number of unretrieved IVC filters in the US," according to , of the University of Rochester Medical Center in New York, and colleagues in their review appearing online in JACC: Cardiovascular Interventions.

, of Massachusetts General Hospital in Boston, congratulated Alkhouli's group for bringing IVC thrombosis into the spotlight, yet noted that their report "highlights the limited scientific data we have to guide us in the management of this disorder."

Long ignored, this "underappreciated condition" is hardly "ever mentioned in discussions about deep venous thrombosis management," Jaff wrote in an accompanying editorial, suggesting that a difficult diagnosis may be partly to blame.

"Counting on the physical examination to reliably yield a diagnosis is fraught with error, as the most common symptoms of IVC thrombosis are likely limb edema, discomfort, and venous varicosities, all common and non-specific findings," he explained.

Yet the authors added that "if untreated, patients with IVC thrombosis will also suffer from significant morbidities: post-thrombotic syndrome in up to 90%, disabling venous claudication in 45%, pulmonary embolism in 30%, and venous ulceration in 15%."

So what can clinicians do when faced with IVC thrombosis?

In the absence of randomized trials or societal guidelines, careful case selection and technical expertise in catheter-directed thrombolysis, with or without pharmacomechanical catheter-directed thrombectomy, are "essential" for the endovascular management of IVC thrombosis, Alkhouli and colleagues suggested; while Jaff wrote that "having a team of specialists from medical, surgical, and endovascular perspectives will undoubtedly offer these challenging patients the best outcomes."

Better yet, operators should focus on prevention right from the time of implantation.

"Given the significant morbidity associated with IVC filter thrombosis, removal of these filters as soon as possible should be planned at the outset," according to the investigators.

"Since IVC filter thrombosis is the main etiology for IVC thrombosis, think once more before placing the filter -- does the patient really need it? If so, pull it out as soon as is safe and reasonable," Jaff agreed.