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World Journal of Surgery

Published in:

01-07-2008

Bedside Placement of Removable Vena Cava Filters Guided by Intravascular Ultrasound in the Critically Injured

Authors: Konstantinos Spaniolas, George C. Velmahos, Christopher Kwolek, Alice Gervasini, Marc De Moya, Hasan B. Alam

Published in: World Journal of Surgery | Issue 7/2008

Abstract

Background

Bedside placement of removable inferior vena cava filters (RVCF) is increasingly used in critically injured patients. The need for fluoroscopic equipment and specialized intensive care unit beds presents major challenges. Intravascular ultrasound (IVUS) eliminates such problems. The objective of the present study was to analyze the safety and feasibility of IVUS-guided bedside RVCF placement in critically injured patients.

Methods

Between October 2004 and July 2006 47 IVUS-guided RVCF were placed at the bedside. Medical and trauma registry records were reviewed. Primary outcome was RVCF-related complications.

Results

The mean patient age was 41 ± 19 years, and the mean Injury Severity Score was 30 ± 12. The right common femoral vein was chosen as the site of access in 40 patients, and the left common femoral vein was the access site in 7 patients. The insertion was performed 3.7 ± 2.5 days after admission. Four patients (8.5%) developed common femoral deep vein thrombosis (DVT) and three (6%) developed a peripheral pulmonary embolism (PE). Complications related to technique were recorded in two patients (4%) and included one misplacement and one access site bleeding with no further associated morbidity. Five patients died during the hospital stay from issues unrelated to RVCF. Forty-one patients were eligible for follow-up. Removal of RVCF was offered only to 8 patients and was performed successfully in 4 (10%) at a mean of 130 days (range: 44–183 days).

Conclusions

In this study IVUS-guided bedside placement of RVCF was feasible but was also associated with complications. Follow-up was poor, and the rate of removal disappointingly low, underscoring the need for further exploration of the role of RVCF.

Neuerburg JM, Günther RW, Vorwerk D et al (1997) Results of a multicenter study of the retrievable Tulip vena cava filter: early clinical experience. Cardiovasc Intervent Radiol 20:10–16PubMedCrossRef

Bovyn G, Gory P, Reynaud P et al (1997) The Tempofilter: a multicenter study of a new temporary caval filter implantable for up to six weeks. Ann Vasc Surg 11:520–528PubMedCrossRef

Van Natta TL, Morris JA, Eddy VA et al (1998) Elective bedside surgery in critically injured patients is safe and cost-effective. Ann Surg 227:618–624PubMedCrossRef

Friedman Y, Fildes J, Mizock B et al (1996) Comparison of percutaneous and surgical tracheostomies. Chest 110:480–485PubMedCrossRef

Sing RF, Smith CH, Miles WS et al (1998) Preliminary results of bedside inferior vena cava filter placement: safe and cost-effective. Chest 114:315–316PubMedCrossRef

Rogers FB, Shackford SR, Wilson J et al (1993) Prophylactic vena cava filter insertion in severely injured trauma patients: indications and preliminary results. J Trauma 35:637–641PubMed

Joels CS, Sing RF, Heniford BT (2003) Complications of inferior vena cava filters. Am Surg 69:654–659PubMed

Savin MA, Panicker HK, Sadiq S et al (2002) Placement of vena cava filters: factors affecting technical success and immediate complications. AJR Am J Roentgenol 179:597–602PubMed

Ginzburg E, Cohn SM, Lopez J et al (2003) Miami Deep Vein Thrombosis Study Group. Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma. Br J Surg 90:1338–1344PubMedCrossRef

10.

Geerts WH, Code KI, Jay RM et al (1994) A prospective study of venous thromboembolism after major trauma. N Engl J Med 331:1601–1606PubMedCrossRef

11.

Spinal Cord Injury Thromboprophylaxis Investigators (2003) Prevention of venous thromboembolism in the acute treatment phase after spinal cord injury: a randomized, multicenter trial comparing low-dose heparin plus intermittent pneumatic compression with enoxaparin. J Trauma 54:1116–1124CrossRef

12.

Acosta JA, Yang JC, Winchell RJ et al (1998) Lethal injuries and time to death in a level I trauma center. J Am Coll Surg 186:528–533PubMedCrossRef

13.

Decousus H, Leizorovicz A, Parent F et al for the Prévention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group (1998) A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med 338:409–415

14.

PREPIC Study Group (2005) Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 112:416–422CrossRef

15.

Rogers FB, Shackford SR, Ricci MA et al (1995) Routine prophylactic vena cava filter insertion in severely injured trauma patients decreases the incidence of pulmonary embolism. J Am Coll Surg 180:641–647PubMed

16.

Rodriguez JL, Lopez JM, Proctor MC et al (1996) Early placement of prophylactic vena caval filters in injured patients at high risk for pulmonary embolism. J Trauma 40:797–802PubMed

17.

Khansarinia S, Dennis JW, Veldenz HC et al (1995) Prophylactic Greenfield filter placement in selected high-risk trauma patients. J Vasc Surg 22:231–235PubMedCrossRef

18.

McMurtry AL, Owings JT, Anderson JT et al (1999) Increased use of prophylactic vena cava filters in trauma patients failed to decrease overall incidence of pulmonary embolism. J Am Coll Surg 189:314–320PubMedCrossRef

19.

Rosenthal D, McKinsey JF, Levy AM et al (1994) Use of the Greenfield filter in patients with major trauma. Cardiovasc Surg 2:52–55PubMed

20.

Rosenthal D, Wellons ED, Lai KM et al (2006) Retrievable inferior vena cava filters: initial clinical results. Ann Vasc Surg 20:157–165PubMedCrossRef

21.

Garrett JV, Passman MA, Guzman RJ et al (2004) Expanding options for bedside placement of inferior vena cava filters with intravascular ultrasound when transabdominal duplex ultrasound imaging is inadequate. Ann Vasc Surg 18:329–334PubMedCrossRef

22.

Ebaugh JL, Chiou AC, Morasch MD et al (2001) Bedside vena cava filter placement guided with intravascular ultrasound. J Vasc Surg 34:21–26PubMedCrossRef

23.

Rogers FB, Strindberg G, Shackford SR et al (1998) Five-year follow-up of prophylactic vena cava filters in high-risk trauma patients. Arch Surg 133:406–411PubMedCrossRef

24.

Bovyn G, Ricco JB, Reynaud P et al, for the European Tempofilter II Study Group (2006) Long-duration temporary vena cava filter: a prospective 104-case multicenter study. J Vasc Surg 43:1222–1229

25.

Binkert CA, Sasadeusz K, Stavropoulos SW (2006) Retrievability of the recovery vena cava filter after dwell times longer than 180 days. J Vasc Interv Radiol 17:299–302PubMedCrossRef

26.

Indeck M, Peterson S, Smith J et al (1988) Risk, cost, and benefit of transporting ICU patients for special studies. J Trauma 28:1020–1025PubMed

27.

Braman SS, Dunn SM, Amico CA et al (1987) Complications of intrahospital transport in critically ill patients. Ann Intern Med 107:469–473PubMed

28.

Smith I, Fleming S, Cernaianu A (1990) Mishaps during transport from the intensive care unit. Crit Care Med 18:278–281PubMedCrossRef

29.

Nunn CR, Neuzil D, Naslund T et al (1997) Cost-effective method for bedside insertion of vena caval filters in trauma patients. J Trauma 43:752–758PubMedCrossRef

30.

Bonn J, Liu JB, Eschelman DJ et al (1999) Intravascular ultrasound as an alternative to positive-contrast vena cavography prior to filter placement. J Vasc Interv Radiol 10:843–849PubMed

31.

Rosenthal D, Wellons ED, Lai KM et al (2005) Retrievable inferior vena cava filters: early clinical experience. J Cardiovasc Surg (Torino) 46:163–169

32.

Rosenthal D, Wellons ED, Levitt AB et al (2004) Role of prophylactic temporary inferior vena cava filters placed at the ICU bedside under intravascular ultrasound guidance in patients with multiple trauma. J Vasc Surg 40:958–964PubMedCrossRef

33.

Wellons ED, Rosenthal D, Shuler FW et al (2004) Real-time intravascular ultrasound-guided placement of a removable inferior vena cava filter. J Trauma 57:20–23PubMed

34.

Ashley DW, Gamblin TC, McCampbell BL et al (2004) Bedside insertion of vena cava filters in the intensive care unit using intravascular ultrasound to locate renal veins. J Trauma 57:26–31PubMedCrossRef

35.

Wellons ED, Matsuura JH, Shuler FW et al (2003) Bedside intravascular ultrasound-guided vena cava filter placement. J Vasc Surg 38:455–457PubMedCrossRef

36.

Oppat WF, Chiou AC, Matsumura JS (1999) Intravascular ultrasound-guided vena cava filter placement. J Endovasc Surg 6:285–287PubMedCrossRef

37.

Tola JC, Holtzman R, Lottenberg L (1999) Bedside placement of inferior vena cava filters in the intensive care unit. Am Surg 65:833–837; discussion 837–838PubMed

38.

Vassiliu P, Sava J, Toutouzas KG et al (2002) Is contrast as bad as we think? Renal function after angiographic embolization of injured patients. J Am Coll Surg 194:142–146PubMedCrossRef

39.

Hoff WS, Hoey BA, Wainwright GA et al (2004) Early experience with retrievable inferior vena cava filters in high-risk trauma patients. J Am Coll Surg 199:869–874PubMedCrossRef

40.

Stefanidis D, Paton BL, Jacobs DG et al (2006) Extended interval for retrieval of vena cava filters is safe and may maximize protection against pulmonary embolism. Am J Surg 192:789–794PubMedCrossRef

41.

Duperier T, Mosenthal A, Swan KG et al (2003) Acute complications associated with greenfield filter insertion in high-risk trauma patients. J Trauma 54:545–549PubMedCrossRef

42.

Wojcik R, Cipolle MD, Fearen I et al (2000) Long-term follow-up of trauma patients with a vena caval filter. J Trauma 49:839–843PubMed

43.

Allen TL, Carter JL, Morris BJ et al (2005) Retrievable vena cava filters in trauma patients for high-risk prophylaxis and prevention of pulmonary embolism. Am J Surg 189:656–661PubMedCrossRef

44.

Antevil JL, Sise MJ, Sack DI et al (2006) Retrievable vena cava filters for preventing pulmonary embolism in trauma patients: a cautionary tale. J Trauma 60:35–40PubMed

45.

Kirilcuk NN, Herget EJ, Dicker RA et al (2005) Are temporary inferior vena cava filters really temporary? Am J Surg 190:858–863PubMedCrossRef

46.

Morris CS, Rogers FB, Najarian KE et al (2004) Current trends in vena caval filtration with the introduction of a retrievable filter at a level I trauma center. J Trauma 57:32–36PubMed

47.

Grande WJ, Trerotola SO, Reilly PM et al (2005) Experience with the recovery filter as a retrievable inferior vena cava filter. J Vasc Interv Radiol 16:1189–1193PubMed

48.

Karmy-Jones R, Jurkovich GJ, Velmahos GC et al (2007) Practice patterns and outcomes of retrievable vena cava filters in trauma patients: an AAST multicenter study. J Trauma 62:17–25PubMed

Title: Bedside Placement of Removable Vena Cava Filters Guided by Intravascular Ultrasound in the Critically Injured
Authors: Konstantinos Spaniolas
George C. Velmahos
Christopher Kwolek
Alice Gervasini
Marc De Moya
Hasan B. Alam
Publication date: 01-07-2008
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 7/2008
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-008-9523-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Bedside Placement of Removable Vena Cava Filters Guided by Intravascular Ultrasound in the Critically Injured

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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