The next frontier of office-based inferior vena cava filter placement.

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There is an increasing number of procedures that traditionally were performed in the inpatient setting that arenow becoming office-based procedures. These include peripheral endovascular procedures such as angiograms, angioplasties, dialysis access interventions, and treatment for venous insufficiency. We chose to evaluate the feasibility, safety of inferior vena cava (IVC) filter placement in the office-based setting. All procedures were performed using local anesthesia, and ultrasound guidance for puncture. All venograms were performed with manual injection of iodinated contrast. An IVC filter was placed in the cases (except one failure of placement) using fluoroscopy in the infrarenal position. Patients were observed in a recovery area and then discharged. Follow-up data were obtained through an interview, physical examination, and 24-hour postoperative phone call. Over the course of 27months, 29 Greenfield filters (Boston Scientific, Marlborough, Mass) and three Celect temporary filters (Cook, Bloomington, Ind) were placed in the infrarenal IVC for 18 women and 14 men, with an average age of 75.3± 15.6years (range, 38-97years). Twenty-four acute, 6 recent (<6months ago) and three subacute lower extremity deep vein thromboses (DVTs) wereidentified. The indications for the procedure were patients with: DVT who were to undergo surgery (n= 6),acute large free-floating iliofemoral DVT (deemed high-risk for long-term anticoagulation) (n=7), new DVTduring anticoagulation therapy (n= 6), DVT with gastrointestinal bleeding (n= 4), DVT withhematuria (n= 2), recent DVT (which extended during fulldose anticoagulation treatment) while undergoing a longflight (n= 1) (temporary filter placement), DVTwith arm hematoma (n= 1), DVT with unsteady gaitand history offalls (n= 2), DVT with nose bleeding(n= 1), DVT withdementia and inability to receive anticoagulation treatment (n= 1), DVT and receiving chemotherapy and withthrombocytopenia (n= 1), and DVT and refusal to takeanticoagulation medication(n= 1). One patient had afailure to place a filterbecause of chronic IVC occlusion found on venogram.One patient with history of gastrointestinal bleeding,acute DVT, and atrial fibrillation suffered IVC filterthrombosis 1month after the procedure. We attemptedremoval of the temporary filters in the hospital in two patients but failed to retrieve the filter in thesetwo cases.We noted no insertion site DVT, extension ofDVT, orpulmonary embolism. Our preliminary experience suggests that placement of IVC filters for treatment of venous thrombotic eventsin an office-based facility is safe and efficacious with basic endovascular equipment. Long-term outcome cannot be determined at this point.