Office-Based IVC Filter Placement: The Next Frontier

Abstract

An increasing number of procedures that traditionally were performed in the inpatient setting are now becoming office-based procedures. These include peripheral endovascular procedures such as angiograms, angioplasties, dialysis-access interventions, and venous insufficiency treatments. These have been performed in the office with minimal complications. We chose to evaluate the feasibility, safety of inferior vena cava (IVC) filter placement in the office-based setting. All procedures were performed under local anesthesia and using ultrasound guidance for puncture. All venograms were performed with hand injection of dye. An IVC filter was placed in the cases (except one failure of placement) under fluoroscopy at the level of L2-L3 in the infrarenal position. Patients were observed in a recovery area and discharged to home. Follow-up data were obtained through an interview, physical examination, and 24-hour postoperative phone call. At 1 week, duplex of the IVC filter and the puncture site was performed. At the 3-month follow-up, a venous and IVC duplex scan was performed. Over the course of 27 months, 29 Greenfield filters and 3 Celect temporary filters were placed in infrarenal IVC for 18 women and 14 men, with average age of 76.1 years (range, 38-97; standard deviation, ±15.1 years). Failure to place a filter occurred in one patient due to chronic IVC occlusion. The indications for the procedure were acute free-floating DVT in 10, contraindication to anticoagulation in 13, failure of anticoagulation in 5, high-risk patients in 2, patient-related contraindication such as dementia in 2, and refusal to be anticoagulated in 1. One 89-year-old patient had IVC filter thrombosis 2 months after placement of the IVC filter. The remainder of patients did not experience any complications, including but not limited to infection, bleeding, filter thrombosis, insertion-site thrombosis, perforation of the vena cava, recurrent pulmonary embolism, admission to the hospital, and death, within 24 hours (n = 32), 1 week (n = 32), and 3 months (n = 25) of follow-up time. Our preliminary experience suggests that placement of IVC filters for treatment of venous thrombotic events in an office-based facility is safe and efficacious with basic endovascular equipment. The long-term outcome cannot be determined at this point.