Percutaneous femoral vein access for inferior vena cava filter placement does not cause insertion-site thrombosis

The efficacy of inferior vena cava (IVC) filters in the prevention of pulmonary embolism in patients with lower extremity deep venous thrombosis (DVT) has been well described. What remains uncertain is the risk of insertion-site thrombosis of the femoral vein after filter placement. Historically, the risk was relatively high, most likely due to large delivery systems and therefore a need for longer compression at the insertion site to provide hemostasis. The purpose of this prospective study was to determine the incidence of thrombus formation at the femoral vein puncture site after percutaneous insertion of contemporary IVC filters.

From October 2010 to November 2011, 61 consecutive patients underwent placement of an IVC filter by 3 vascular surgeons and 3 interventional radiologists at our tertiary-care Level I trauma center. All filters were inserted through the right or left common femoral vein. Duplex ultrasound studies (DUS) were performed within 24 hours before filter placement and 24‒72 hours after filter placement.

Fifty-six patients completed the study, including 46 men and 10 women. They ranged in age from 19 to 90 (mean 50) years. Forty-one filters (73%) were placed for prophylaxis: 39 of the patients were trauma victims with immobility and/or contraindications to anticoagulation, 1 had an intracranial hemorrhage with an underlying malignancy, and 1 had very limited mobility. The remaining 15 filters (27%) were placed because of an acute DVT with a contraindication to or a complication from anticoagulation. The filters utilized were: Boston Scientific-Greenfield (n=25); Cook-Celect (n=18); Bard-G2X (n=2); Bard-Eclipse (n=6); and Cordis-TrapEase (n=5). Sheath diameters ranged from 6- to 12-French. None of the 56 patients had thrombus formation at the insertion site on follow-up DUS.

Based on our study findings, the risk of femoral insertion-site thrombosis after percutaneous placement of contemporary IVC filters is negligible. Concern for femoral vein thrombosis should not be a reason for using the internal jugular vein to deploy IVC filters.