Bedside vena cava filter placement guided with intravascular ultrasound

The purpose of this study was to report a feasibility trial approved by the Institutional Review Board for insertion of inferior vena cava (IVC) filters with intravascular ultrasound (IVUS) guidance in the intensive care unit.

Between October 1998 and May 2000, 26 patients (15 men, 11 women; age range, 22-86 years; mean, 55 years) were enrolled. Eight patients (31%) underwent prophylactic filter placement, and 18 patients (69%) had venous thromboembolism (deep venous thrombosis = 16, pulmonary embolism = 2) with contraindications to anticoagulation. A single groin puncture was used for IVUS and filter placement. Location of major branch veins, thrombosis, and caval diameter were readily demonstrated without the use of radiocontrast agents. Mapping of the IVC permitted assessment of ideal filter location. Postprocedure radiographs (23 of 26) were obtained to document filter position. Seventeen of 26 had follow-up lower extremity duplex studies.

Twenty-four (92%) of 26 patients underwent successful filter deployment. The two other patients had filters subsequently placed by means of traditional fluoroscopic techniques. One femoral vein insertion site thrombosis resolved after a month. One patient experienced symptomatic caval thrombosis thought to be caused by thrombus trapping 55 days after the procedure. No pulmonary emboli occurred after filter placement. One patient's death was unrelated to vena cava filter placement. The hospital charge for bedside filters was $3623 compared with $4165 (P =.281) for fluoroscopic placement.

Bedside insertion of an IVC filter with IVUS guidance is feasible and may be an effective alternative in the intensive care unit. No additional costs were incurred in this small series. Protocol refinements should reduce the incidence of complications. The results of this study support the need for further evaluation comparing it with standard techniques.