The Bedside Insertion of Inferior Vena Cava Filters Using Ultrasound Guidance

Abstract

Since the introduction of inferior vena cava (IVC) filters more than 30 years ago, there has been a steady improvement in the design, ease, and safety of the delivery systems. Today, all of the commonly used filters can be placed via a peripheral vein by using standard percutaneous Seldinger technique. However, this typically requires fluoroscopy, intravenous contrast agents, radiation exposure, and transport of the patient to the interventional or operating suite. In the multiply injured trauma or critically-ill intensive care unit patient, often requiring inotropic and ventilator support, transport to these facilities can be hazardous. In addition, these patients frequently have a combination of neurospinal and long bone injuries, which require skeletal immobilization, thus further complicating transportation. Advancing technology with portable duplex ultrasound and improved deep abdominal duplex imaging has allowed for routine diagnostic evaluation of the IVC, renal veins, and surrounding visceral structures. This degree of accuracy has allowed numerous centers to gain experience with ultrasonic imaging of the IVC and insertion site after a filter has been placed. A logical progression has evolved to the point in which, today, duplex ultrasound can be used to guide the insertion of IVC filters. The following describes, in detail, a technique for the percutaneous placement of an IVC filter at the bedside using only duplex ultrasound guidance. The article also briefly compares and contrasts this technique with an alternate technique using intravascular ultrasound. Vena caval interruption can be safely performed under ultrasound guidance in a monitored, intensive care unit environment. In selected intensive care unit or multiply injured trauma patients, this will reduce the risk, complexity and cost of transport for these critically ill patients. Duplex-guided IVC filter placement also reduces procedural costs compared to an operating room or interventional suite, and eliminates intravenous contrast material exposure.

Implante de filtro em veia cava inferior dupla: relato de caso e revisão da literatura

“…Some authors have also described filter placement using ultrasound control when there is a duplicated vena cava. [6][7][8] There are few reports of filter placement in the vena cava in this situation. We report a case of vena cava filter placement in suprarenal position in a patient with duplicated IVC.…”

Technical Factors Affecting the Accuracy of Bedside IVC Filter Placement Using Intravascular Ultrasound

“…Our 6% incidence of filter malposition is similar to the reported series (0-7%) using double puncture, pullback or single puncture, and single sheath techniques. [1][2][3][4][5][6][7][8][9][10]12 Filter tilt was recorded in only 3 of these institutional series, but we have shown that filter excessive tilt and malpositioning were most prevalent with procedures done via left femoral access and can be minimized with a single puncture, single sheath technique through a right femoral access site. Use of preprocedural duplex ultrasound to evaluate the right common femoral vein is recommended.…”

Deep vein thrombosis and pulmonary embolism - Prevention, management, and anaesthetic considerations

“…Inferior vena cava filter (IVC filter)[431–3234–36] is indicated in patients having complications or contraindications to anticoagulant therapy. However, there is an increased incidence of recurrent DVT 1-2 years after insertion of IVC filter.…”