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PVSS20. Successful Single Puncture Intravascular Ultrasound Directed Inferior Vena Cava Filter Placement

Robert S. Brumberg, Murray L. Shames, Patrick A. Stone, Joe Chauvapun, Martin R. Back, Brad L. Johnson, Dennis F. Bandyk.
University of South Florida, Tampa, Fla.

OBJECTIVES: When contraindications to anticoagulant therapy exist for thromboembolic disease, interruption of the inferior vena cava (IVC) may prevent fatal pulmonary embolism. The technique of contrast venography has been used to secure placement of an IVC filter at the expense of nephrotoxic contrast and radiation. Intravascular ultrasound (IVUS) has been shown to be a safe and effective method to assist IVC filter placement utilizing double-puncture and bilateral femoral access techniques. These poly-puncture approaches increase the risk for femoral vein thrombosis. This investigation describes our single puncture bedside IVUS only approach to IVC filter deployment.

METHODS: From December 2005 to January 2007, thirty patients met criteria for the bedside IVUS only approach for IVC filter placement. Eight females and 22 male patients had a mean age 69 years (range 25-82). Indications for filter placement include DVT (n=13), immobility prophylaxis (n=10), intracranial hemorrhage (n=5), and pulmonary embolism (n=2). Prior to procedure, venous duplex ultrasound testing verified a patent iliofemoral venous segment. Once a patent venous system was confirmed, an 8 Fr low profile IVC filter was deployed with IVUS through a single femoral access site. Mean operative time was 19 minutes (range 13-42 minutes). A post-procedure abdominal radiograph confirmed deployment.

RESULTS: All patients had patent renal veins and a thrombus free IVC prior to filter deployment as studied by IVUS. The IVC diameter was less than 30mm in all patients allowing an 8 Fr profile system filter to be utilized. Twelve (40%) patients were morbidly obese (BMI>40). Twenty-nine (97%) filters were successfully deployed in the infrarenal IVC without complication. In one patient, the tip of the filter was suprarenal. This placement was early in our experience. Current follow-up has demonstrated neither renal thrombosis nor kidney failure. One prolonged operative time (42 minutes) was secondary to morbid obesity. Neither access nor systemic complications were associated with filter placement.

CONCLUSIONS: The use of intravascular ultrasound for bedside IVC filter placement is safe and effective. This technique avoids the need for transport in critically ill patients, and provides imaging for patients too large for conventional fluoroscopy units. Additionally, our technique can further reduce potential double puncture and bilateral femoral vein complications by isolating a single access - single puncture site for filter deployment.