Clinical experience with the antecubital Simon nitinol IVC filter

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiology

Background:

• Pulmonary embolism (PE) poses a significant risk, particularly for patients with contraindications or complications related to anticoagulation.
• Traditional anticoagulation is not always a viable option for PE prevention.
• The antecubital vein offers a potential alternative access site for inferior vena cava (IVC) filter placement.

Purpose of the Study:

• To evaluate the safety and efficacy of the Simon nitinol vena cava filter (SNF) when inserted via the antecubital vein.
• To assess insertion site variables, filter efficacy, and complication rates.
• To explore the feasibility of concomitant peripherally inserted central catheter (PICC) placement via the same antecubital access.

Main Methods:

• A prospective study involving 74 consecutive patients undergoing antecubital SNF insertion over 29 months.
• Concomitant PICC insertion was performed in 23 patients.
• Clinical follow-up was available for 61 patients, with a mean follow-up of 124 days.

Main Results:

• Successful SNF placement via the antecubital vein was achieved in 98.6% of patients.
• One patient required common femoral vein access due to failed arm access.
• No complications were reported related to SNF or PICC placement, with only two cases of suspected PE post-procedure.

Conclusions:

• Antecubital venous insertion of the SNF is a safe and effective strategy for PE prevention in patients unsuitable for anticoagulation.
• This approach provides an option for simultaneous PICC insertion without increasing procedural risks.
• The antecubital approach offers a viable alternative for IVC filter placement.