Bedside intravascular ultrasound-guided inferior vena cava filter placement in medical-surgical intensive care critically-ill patients

Abstract

Introduction and objectivePulmonary Embolism (PE) is a potentially life-threatening complication of critical illness. Prophylactic inferior vena cava filter (IVC) placement offers a protection rate of 99% against fatal PE. Transportation of critically ill patients from the intensive care unit to the interventional radiology suit is a potential risk and cumbersome. Bedside IVC filter placement offers protection against fatal PE without added risk of transportation. Transabdominal ultrasound visualization of the IVC can be difficult because of patient body habitus or recent abdominal surgeries. Intravascular Ultrasound (IVUS) is an appealing imaging guidance that does not have this limitation. We are aiming at evaluation the safety and outcome of bedside IVUS-guided Günther Tulip filter placement in the intensive care units patients. ResultsThe single venous access technique via the femoral vein was used. Filter placement was successful in 95% of cases (35/37). In two earlier cases filters misplaced at the right iliocaval confluence were fluoroscopically repositioned in the infrarenal IVC. Neither PE nor PE-related mortality was recorded. Renal impairment was seen in 35% of cases (n=13/37). The body mass index calculation in 27 patients revealed obesity in 67% of the patients. ConclusionsBedside IVUS-guided filter placement in medical-surgical critically ill patient in intensive care unit is a feasible, safe and reliable technique for IVC interruption. IVUS may be the most appropriate tool to guide filter insertion in obese patient.