Comparison of Inferior Vena Cava Filters Placed at the Bedside via Intravenous Ultrasound Guidance Versus Fluoroscopic Guidance

Inferior Vena Cava Filters and Complications: A Systematic Review

Inferior vena cava (IVC) filters have been used since the 1960s to treat patients with acute risk of pulmonary embolism (PE) to prevent migration of thrombus by trapping it within the filter. Traditional usage has been in patients with contraindication to anticoagulation that carry a significant mortality risk. In this systematic review, we sought to evaluate complications associated with placement of inferior vena cava filters based on published data from the past 20 years. A search was performed on October 6th, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews, using three databases (ProQuest, PubMed and ScienceDirect) for articles published between the dates of February 1, 2002 and October 1, 2022. Results were filtered to include full-text, clinical studies, and randomized trials written in English pertaining to keywords "IVC filter AND complications", "Inferior Vena Cava Filter AND complications", "IVC filter AND thrombosis" and "Inferior Vena Cava Filter AND thrombosis". Articles identified by the three databases were pooled and further screened for relevance based on inclusion and exclusion criteria. Initial search results yielded 33,265 hits from all three databases combined. Screening criteria were applied, with 7721 results remaining. After further manual screening, including removal of duplicate hits, a total of 117 articles were selected for review. While there are no consensus guidelines for best practice, there is compelling evidence that IVC filters can provide significant protection against PE with minimal complications if the treatment window is appropriate. Increase in the variety of filter models has led to broader availability, but skepticism remains about their efficacy and safety, with ongoing controversy surrounding appropriate indications. Further research is needed to establish clear guidelines on appropriate indications for IVC placement and to determine time course of complications versus benefits for indwelling filters.

Digital radiograph (DR) guided bedside IVC filter placements in patients with intracranial pressure monitors

Purpose

The purpose of this study is to report a single center experience with portable digital radiographically (DR) guided bedside IVC filters placed in intensive care unit (ICU) patients with high ICP and elevated head of bed (HOB).

Materials and methods

A retrospective chart review was conducted on all bedside IVC filters placed from January 1, 2010 to September 16, 2020. Patients with high ICP and elevated head of bed requirements were included. Charts were reviewed for filter type, common femoral vein (CFV) access, filter location, pre procedure imaging, pre and post filter ICPs, glascow coma scale, number of radiographs taken, and filter removal. ICPs were obtained 1 ​h prior to procedure and 2 ​h post procedure and analyzed with a paired T test.

Filters were placed by reviewing prior CT scan for IVC size, caval variants, renal and iliac veins and vertebral body landmarks. Then, CFV access was obtained and a Bentson wire was advanced 30–40 ​cm. A radiograph was used to confirm adequate position of the of the wire. The filter sheath was advanced and serial radiographs were used to position the filter sheath at the final predetermined position below the renal veins and above the iliac bifurcation. The filter was deployed, and a radiograph was obtained to confirm filter positioning.

Results

A total of 9 DR guided bedside IVC filters were placed (4 Denali, 3 Option Elite, 2 Celect). Indications included prophylactic placement (n ​= ​8) and acute DVT (n ​= ​1). The average patient age was 35.8 years (range: 18–56 years) CT abdomen and pelvis was used to assess for the level of renal veins in all patients (n ​= ​9). No caval variants were encountered on pre-procedural planning. The average pre, intraprocedural, and post procedure intracranial pressure was 16 ​mmHg, 13 ​mmHg, and 16 ​mmHg, respectively. Confirmation of placement after final placement was available in 7 patients (4 DR, 2 CT and one fluoroscopic examination). Two non-procedural related deaths occurred.

Technical success, defined as successful placement of IVC filter at the predetermined level, was achieved in 100% of patients (n ​= ​9). The right CFV was used in most patients (n ​= ​7). The left CFV was used for access in two patients due to right CFV thrombus (n ​= ​1) and existing right femoral venous central line (n ​= ​1). The average number of radiographs taken was 5.8 (range 4–9). In all cases, filters were placed below the level of the lowest renal vein (n ​= ​9). A comparison of pre, during and post intervention ICP pressures is shown in table, 2. No differences between pre and post filter ICP was noted (p ​= ​0.77). Three filters were later removed. One minor complication was reported, which was filter tilt (23%) in an Option filter.

Conclusion

Bedside IVC filters can be safely placed in patients with head trauma and high ICP who are unable to lay supine using portable DR guidance with a high rate of technical success and minimal complications.

Feasibility study of hand-carried ultrasound-guided retrievable inferior vena cava filter placement

Background

With the development of ultrasonic diagnostic techniques in recent years, ultrasound-guided placement of inferior vena cava (IVC) filters has been widely used in clinics, and satisfactory results have been achieved. Our study aims to observe the accuracy of hand-carried ultrasound-guided retrievable vena cava filter placement, evaluate the feasibility and safety of this new method, and provide a scientific and effective interventional method and clinical data to prevent acute pulmonary embolism (PE) after battle injury of limbs.

Methods

Two hundred patients with post-traumatic thrombosis of the extremities were enrolled. The renal vein was located under the guidance of hand-carried ultrasound. The retrievable filter was fixed 1–2 cm below the opening of the renal vein. The self-expanding filter was used after the filter’s position was confirmed by injecting the contrast agent under the digital subtraction angiography (DSA) fluoroscopy.

Results

All the 200 patients underwent the operation successfully. The position of the hand-carried ultrasound localizer was consistent with the DSA localizer. All the filters were expanded smoothly. No complications related to the operation occurred.

Conclusions

The study concluded that the hand-carried ultrasound-guided retrievable vena cava filter placement has a high success rate and can prevent acute PE after limbs’ battle injury.

Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease: Developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine

PURPOSE

To provide evidence-based recommendations on the use of inferior vena cava (IVC) filters in the treatment of patients with or at substantial risk of venous thromboembolic disease.

MATERIALS AND METHODS

A multidisciplinary expert panel developed key questions to address in the guideline, and a systematic review of the literature was conducted. Evidence was graded based on a standard methodology, which was used to inform the development of recommendations.

RESULTS

The systematic review identified a total of 34 studies that provided the evidence base for the guideline. The expert panel agreed on 18 recommendations.

CONCLUSIONS

Although the evidence on the use of IVC filters in patients with or at risk of venous thromboembolic disease varies in strength and quality, the panel provides recommendations for the use of IVC filters in a variety of clinical scenarios. Additional research is needed to optimize care for this patient population.

Comparative analysis of technical success rates and procedural complication rates of bedside inferior vena cava filter placement by intraprocedural imaging modality

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.

New method for ultrasound-guided inferior vena cava filter placement

OBJECTIVE

Transabdominal ultrasound (TAUS)-guided inferior vena cava filter (IVCF) placement currently uses an inferior vena cava (IVC) longitudinal plane with cross-section of the right renal artery or the transverse plane of the right renal vein (RRV)-IVC intersection. The goal of this study was to introduce a new method for TAUS-guided IVCF placement.

METHODS

The study enrolled patients who were at high risk for or had pulmonary embolism from October 22, 2010, to June 30, 2016. The probe was positioned on the right flank to centralize the RRV-IVC junction during imaging and to permit a straight line through the midpoint of the probe on the surface and a parallel line 1.0 cm below the straight line as a marker. The probe was subsequently placed on the abdominal wall with the upper edge at the marker line to show the long axis of the IVC during the process of filter placement. The upper edge of the probe was considered the filter tip position.

RESULTS

A total of 1029 patients were evaluated, and 98 patients (9.5%) were excluded because of poor IVC visualization (n = 14 [1.4%]), IVC or bilateral iliac vein thrombosis (n = 79 [7.7%]), and unsuitable anatomy (n = 5 [0.5%]). The remaining 931 patients (90.5%) were selected for TAUS-guided IVCF placement, and all filters (100%) were successfully placed. There were no procedure-related complications. Suprarenal IVCF was observed in 4 patients (0.4%) by computed tomography, and the filter tip exceeded the upper edge of L2 in 15 patients (1.6%) by plain film radiography; one of them had two RRVs. Severe filter tilting (20.8 degrees) occurred in one patient.

CONCLUSIONS

This new method of TAUS-guided IVCF placement was simple, safe, and effective. It may be widely applied for the bedside placement of vena cava filters.