Duplex scan–directed placement of inferior vena cava filters: A five-year institutional experience

Abstract

Purpose: The purpose of this study was the assessment of the safety, efficacy, and hospital charges of bedside duplex ultrasound–directed inferior vena cava (IVC) filter placement. Methods: All duplex ultrasound–directed IVC filters that were placed from August 8, 1995, to December 31, 2000, are reviewed. Chart review combined with mailed questionnaires and telephone follow-up examinations were used to collect demographic and outcome data. Results: Three hundred twenty-five patients underwent evaluation, and 284 underwent duplex ultrasound–directed IVC filter placement. Two hundred three (71%) were male patients, and 81 (29%) were female patients. Poor IVC visualization, IVC thrombosis, and unsuitable anatomy prevented duplex-directed filter placement in 41 patients (12%). Indication for filter placement included venous prophylaxis in the absence of thromboembolism in 235 patients (83%), contraindication to anticoagulation therapy in 34 patients (12%), prophylaxis with therapeutic anticoagulation therapy in the presence of thromboembolism in 7 patients (2%), and complication of anticoagulation therapy in 8 patients (3%). There were no procedure-related deaths or septic complications. Technical complications occurred in 12 patients (4%). Filter misplacement occurred in 6 patients (2%), access thrombosis in 1 (<1%), migration in 1 (<1%), bleeding in 1 (<1%), and IVC occlusion in 3 (1%). Pulmonary emboli after IVC filter placement occurred in one patient with a misplaced filter. Average hospital charges related to duplex ultrasound–directed filter placement were $2388 less than fluoroscopic placement charges in the year 2000. Conclusion: Our experience indicates that duplex ultrasound–directed IVC filter placement is safe, cost-effective, and convenient for patients who need IVC filter placement. (J Vasc Surg 2002;35:286-91.)