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Sengodan P, Sankaramangalam K, Li M, Wang X, Subramaniam S, Alappan N. Comparative analysis of technical success rates and procedural complication rates of bedside inferior vena cava filter placement by intraprocedural imaging modality. J Vasc Surg Venous Lymphat Disord 2019; 7:601-609. [PMID: 31068274 DOI: 10.1016/j.jvsv.2019.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/31/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Transabdominal duplex ultrasound, intravascular ultrasound (IVUS), and fluoroscopy have been used to assist with inferior vena cava filter (IVCF) placement since the late 1990s. We sought to compare the technical success and procedural complications of bedside placement of IVCF by the three commonly used modalities, namely, duplex ultrasound, IVUS, and combined IVUS and fluoroscopy. METHODS All published reports including prospective and retrospective cohort studies and case series with a minimum of 10 patients from inception to August 2017 were identified by an electronic search of PubMed and Embase. The studies were then pooled to create a sample of patient data for statistical analysis. Bonferroni correction was used for comparison of the three groups. Values of P < .017 (two tailed) were considered statistically significant for the pairwise comparisons. RESULTS A total of 21 studies comprising 2166 patients were identified. No significant differences were found in technical success and complication rates between the duplex ultrasound and IVUS arm, the combined IVUS and IVUS with fluoroscopy arm, or the duplex ultrasound and the combined IVUS with fluoroscopy arm. However, there was a trend toward decreased complication rates in the duplex ultrasound arm compared with the other two arms. A trend toward increased technical success was also observed in the combined IVUS and fluoroscopy arm compared with the other two arms. CONCLUSIONS There are no significant differences in the technical success and complication rates between the three commonly used modalities of bedside IVCF placement.
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Affiliation(s)
- Prasanna Sengodan
- Department of Medicine, Cleveland Clinic Foundation - Fairview Hospital, Cleveland, Ohio.
| | | | - Manshi Li
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
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Srivastava A, Troop B, Peick A, Kanne A. Inferior vena cava filter placement at bedside using computed tomography scan information: a new technique for accurate deployment. Am J Surg 2015; 211:172-8. [PMID: 26525532 DOI: 10.1016/j.amjsurg.2015.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/07/2015] [Accepted: 08/16/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND An inferior vena cava filter (IVCF) is indicated for the prophylaxis of pulmonary embolism where anticoagulation is contraindicated. The majority of these filters are placed using fluoroscopy and venogram. We hypothesized that a computed tomography (CT) scan of the abdomen and pelvis provides sufficient information for successful deployment of an IVCF at bedside without the need for any further imaging during the procedure. METHODS A retrospective review of prospectively collected data of a bedside IVCF placement technique using measurements from abdominal/pelvic CT scans without additional intraoperative imaging in 38 patients at a level 1 trauma center was conducted. RESULTS The most common indication for IVCF placement was high-risk patients without deep venous thrombosis. All these procedures were performed at bedside. Nonretrievable (TrapEase) and retrievable (OptEase) type filters were used. All these IVCFs were placed below the renal veins without any complications. CONCLUSIONS IVCFs can be placed based on measurements from abdominal CT scans without the need for further imaging such as fluoroscopy or an inferior vena cava venogram. This technique is as simple as bedside femoral venous line placement.
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Affiliation(s)
- Anil Srivastava
- Division of Trauma/General Surgery, Mercy Hospital, Suite 560 A, 621 S. New Ballas Road, St. Louis, MO, 63141, USA.
| | - Bryan Troop
- Division of Trauma/General Surgery, Mercy Hospital, Suite 560 A, 621 S. New Ballas Road, St. Louis, MO, 63141, USA
| | - Ann Peick
- Division of Trauma/General Surgery, Mercy Hospital, Suite 560 A, 621 S. New Ballas Road, St. Louis, MO, 63141, USA
| | - Antoinette Kanne
- Division of Trauma/General Surgery, Mercy Hospital, Suite 560 A, 621 S. New Ballas Road, St. Louis, MO, 63141, USA
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Abusedera MA, Cho K, Williams DM. Bedside intravascular ultrasound-guided inferior vena cava filter placement in medical-surgical intensive care critically-ill patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Weinberg I, Kaufman J, Jaff MR. Inferior Vena Cava Filters. JACC Cardiovasc Interv 2013; 6:539-47. [DOI: 10.1016/j.jcin.2013.03.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/20/2013] [Accepted: 03/01/2013] [Indexed: 01/29/2023]
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Wehrenberg-Klee E, Stavropoulos SW. Inferior vena cava filters for primary prophylaxis: when are they indicated? Semin Intervent Radiol 2013; 29:29-35. [PMID: 23450194 DOI: 10.1055/s-0032-1302449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Over the past several years there has been a rapid increase in the number of inferior vena cava (IVC) filters placed for primary thromboprophylaxis. Increased use has occurred in settings where other methods of thromboprophylaxis are viewed to be inadequate, technically challenging, or that place patients at an unacceptably high bleeding risk. These clinical services include trauma, bariatric surgery, neurosurgery, cancer, intensive care unit populations, and patients with a relative contraindication to anticoagulation. We review the studies to date addressing filter placement for these indications. Although preliminary data are promising, the patient populations most likely to benefit from prophylactic IVC filter placement have not been well defined, and randomized studies demonstrating efficacy have not been conducted. Moving forward, it will be critical to accomplish these two tasks if IVC filters are to continue to have a role in primary thromboprophylaxis.
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Affiliation(s)
- Eric Wehrenberg-Klee
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
Anticoagulation has been proven to be effective in preventing and treating deep vein thrombosis and pulmonary embolus. However, many critically ill patients are unable to receive anticoagulation or suffer recurrent venous thromboembolism despite adequate treatment. This article examines the use of vena cava filters in the critically ill. Indications for, techniques, and complications of vena cava filter insertion are reviewed. The importance of vena cava filters with the option to be retrieved and bedside insertion in the intensive care unit is emphasized.
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Affiliation(s)
- Lindsay M Fairfax
- Department of Surgery, Carolinas Medical Center, Charlotte, NC 28232, USA
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Forsythe RM, Peitzman AB, DeCato T, Rosengart MR, Watson GA, Marshall GT, Ziembicki JA, Billiar TR, Sperry JL. Early lower extremity fracture fixation and the risk of early pulmonary embolus: filter before fixation? ACTA ACUST UNITED AC 2011; 70:1381-8. [PMID: 21817975 DOI: 10.1097/ta.0b013e318215b928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Venous thromboembolism is a major cause of morbidity and mortality after injury. Prophylactic anticoagulation is often delayed as a result of injuries or required procedures. Those patients at highest risk in this early vulnerable window postinjury are not well characterized. We sought to determine those patients at highest risk for an early pulmonary embolism (PE) after injury. METHODS A retrospective analysis using data derived from a large state wide trauma registry (1997-2007) was performed. Patients with a documented PE and time of occurrence were selected (n = 712). Patients with fat emboli and lower extremity vascular injuries were excluded. Patients with a PE within the first 72 hours of admission (EARLY, n = 122) were compared with those with DELAYED presentation. Kaplan-Meier survival analysis was used to characterize the timing of death between the two groups. Backward stepwise logistic regression was used to determine independent risk factors for EARLY PE relative to those with DELAYED PE. RESULTS EARLY and DELAYED groups were similar in age, gender, Glasgow Coma Scale, emergency department systolic blood pressure, and injury mechanism. The EARLY PE group had a lower Injury Severity Score but injuries more commonly included femur fracture. Kaplan-Meier analysis revealed that EARLY PE patients have a significantly higher risk of early mortality relative to DELAYED PE patients (p = 0.012). Regression analysis revealed that the only independent risk factor for EARLY PE was lower extremity/pelvic orthopedic fixation (<48 hours from injury). The risk of EARLY PE was more than threefold higher (odds ratios, 3.85; 95% CI, 1.9-7.6; p < 0.001) for those who underwent early lower extremity orthopedic fixation versus those who did not. CONCLUSION Early lower extremity/pelvis orthopedic fixation is the single independent predictor of EARLY PE in this patient cohort. Venous thromboembolism/PE prevention strategies should be made a priority in this group of patients, including early preoperative institution of anticoagulation prophylaxis. These results suggest that those with contraindications to early anticoagulation may benefit from insertion of retrievable inferior vena cava filters preoperatively.
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Affiliation(s)
- Raquel M Forsythe
- Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Tiwari A, Saw C, Li M, Mohan I, Daly T, Swinnen J, Richardson A, So S, Young N, Vicaretti M, Fletcher J. Use of inferior vena cava filters in a tertiary referral centre in Australia. ANZ J Surg 2010; 80:364-7. [PMID: 20557513 DOI: 10.1111/j.1445-2197.2009.05082.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To investigate the use of inferior vena cava (IVC) filters in a tertiary referral centre, looking at indication, types of filters and, with temporary/optional filters, removal rates. METHODS Data was collected from a prospective database of all IVC filters inserted from January 2003 to January 2007. Patients' records and radiological imaging were all reviewed. RESULTS 66 patients (40 males) had IVC filters inserted during the study period. The median age of the male patients was 57.5 (21-79) years, and females 56 (24-81). There were 49 (74.2%) temporary/optional filters and 17 (25.8%) permanent filters. The most common indication for filter was a contraindication to anticoagulation for both permanent (64.7%) and temporary/optional filters (77.6%). In the temporary/optional filter group, 38 of 49 (77.6%) patients had documented venous thromboembolism, while in the permanent filter group, this was 14 of 17 (82.4%). Of the optional filters, 22 of 49 (45.8%) have been removed. CONCLUSION More than half (54.2%) of temporary/optional filters were not removed and with potential for long-term complications. A protocol has now being instituted for vascular surgeons to authorize the insertion of filters and to then be responsible for ensuring their removal.
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Affiliation(s)
- Alok Tiwari
- Department of Vascular Surgery, Westmead Hospital, University of Sydney, Westmead, NSW 2145, Australia
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Martin MJ, Blair KS, Curry TK, Singh N. Vena Cava Filters: Current Concepts and Controversies for the Surgeon. Curr Probl Surg 2010; 47:524-618. [DOI: 10.1067/j.cpsurg.2010.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Aidinian G, Fox CJ, White PW, Cox MW, Adams ED, Gillespie DL. Intravascular Ultrasound—Guided Inferior Vena Cava Filter Placement in the Military Multitrauma Patients: A Single-Center Experience. Vasc Endovascular Surg 2009; 43:497-501. [DOI: 10.1177/1538574409334824] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: High velocity fragments have resulted in a multitude of complex injuries in the military patients, placing them at increased risk of venous thromboembolism. Methods: A retrospective analysis was performed of all the intravascular ultrasound (IVUS)-guided bedside inferior vena cava (IVC) filters placed between August 2003 and October 2007. Results: Fourteen patients had bedside IVUS-guided retrievable filter placement. Thirteen males and one female and the mean (+SD) injury severity scores (ISS) was 37.2 (+9.9). The most common causes of injury were explosive devices (57%), gunshot wounds (28%), rocket-propelled grenades (7%), and motor vehicle crashes (7%). Indications for filter insertion were deep venous thrombosis in 36% of patients and pulmonary embolus in 28%. Thirty five percent had filters inserted prophylactically. Conclusions: Military trauma population ISS is considerably higher than what is reported in the civilian population. The bedside IVUS-guided IVC filter insertion is particularly useful in this population.
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Affiliation(s)
- Gilbert Aidinian
- Department of Surgery, Peripheral Vascular Surgery Service, Walter Reed Army Medical Center, Washington, D.C.,
| | - Charles J. Fox
- Department of Surgery, Peripheral Vascular Surgery Service, Walter Reed Army Medical Center, Washington, D.C
| | - Paul W. White
- Department of Surgery, Peripheral Vascular Surgery Service, Eisenhower Army Medical Center, Augusta, Georgia
| | - Mitchell W. Cox
- Department of Surgery, Peripheral Vascular Surgery Service, Walter Reed Army Medical Center, Washington, D.C
| | - Eric D. Adams
- Department of Surgery, Peripheral Vascular Surgery Service, Walter Reed Army Medical Center, Washington, D.C
| | - David L. Gillespie
- Department of Vascular Surgery, University of Rochester Medical Center, Rochester, New York
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Haley M, Christmas B, Sing RF. Bedside insertion of inferior vena cava filters by a medical intensivist: preliminary results. J Intensive Care Med 2009; 24:144-7. [PMID: 19188271 DOI: 10.1177/0885066608330122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The development of percutaneous techniques has allowed vena cava filters to be safely placed at the bedside. Such procedures appear uniquely suited for critically ill patients as they avoid the inherent risks associated with transportation. We report a "medical intensivist's" experience with the placement of 13 percutaneous vena cava filters. Vena cava filters were successfully placed in 12 of 13 patients as confirmed by postplacement venacavograms; 1 placement attempt was aborted because of a completely occluded inferior vena cava. These results suggest that with appropriate training and supervision, medical intensivists can safely insert vena cava filters in the intensive care unit setting. Such a practice appears safe, reduces patient risk associated with intrahospital transport, and may promote cost containment.
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Affiliation(s)
- Michael Haley
- Department of Medicine, Carolinas Medical Center, Charlotte North Carolina, USA.
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Current World Literature. Curr Opin Anaesthesiol 2008; 21:85-8. [DOI: 10.1097/aco.0b013e3282f5415f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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