Bedside Vena Cava Filter Placement Using Intravascular Ultrasound: A Five Year Experience in Critically Ill Patients
Roan J Glocker, Oluwafunmi Awonuga, Zdenek Novak, Benjamin Pearce, Thomas Matthews, Mark Patterson, William Jordan, Jr., Marc Passman
UAB, Birmingham, AL
Background: Initial experience with a prospectively implemented algorithm for bedside vena cava filter placement with intravascular ultrasound (IVUS) has previously been shown to be a safe and effective technique especially for critically ill patients. The purpose of this study is to evaluate the effectiveness of IVUS guided filter placement in critically ill patients with experience now extending out 5 years from implementation.
Methods: All patients undergoing bedside IVUS guided IVC filter placement from 2008-2012 were identified. Records were reviewed based on IVC filter reporting standards. Outcomes data including technical success, complications, and mortality was analyzed at 30 days.
Results: 398 patients underwent bedside IVC filter placement with IVUS. Overall technical success was 97.9% with inability to place filter due to poor visualization (2), and malpositioned filters either above or below the intended infrarenal position (11). An optional filter (Gunter Tulip or Celect) was used in 374 (93.9%) and a permanent filter (Greenfield) in 24 (6.1%). Single puncture technique was performed in 388 (97.4%) with additional dual access required in 10 (2.6%). Periprocedural complications were rare (3.0%) and included malpositioning requiring retrieval and repositioning or additional filter (3), filter tilt ≥ 20º (4), arterio-venous fistula (2), insertion site thrombosis (2), hematoma (1). Comparison of the first and last 100 procedures in the sample population showed that there was a trend towards improved complication rates in the later experience (7.0% vs 2.0%, p=0.08, respectively). There were no deaths related to pulmonary embolism or filter related problems.
Conclusions: Based on 5 years experience with bedside IVC filter placement in critically ill patients, IVUS guided filter techniques continue to be a safe and effective option in this high risk population with a time-dependent improvement in outcome measures.
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