Vena cavography with CO(2) versus with iodinated contrast material for inferior vena cava filter placement: a prospective evaluation.
OBJECTIVE
To determine whether carbon dioxide (CO(2)) vena cavography can safely guide the placement of inferior vena cava (IVC) filters.


METHODS
One hundred nineteen patients were prospectively enrolled in this study. CO(2 )cavograms were obtained and evaluated for IVC diameter, location of renal veins, and presence of thrombus and venous anomalies. If CO(2 )cavography was judged to be adequate, an IVC filter was deployed. After filter placement, cavography was performed with iodinated contrast material; these images were compared with the CO(2) cavograms.


RESULTS
Two patients experienced mild side effects related to venous CO(2) injection. Comparison of cavograms obtained with CO(2) and iodinated contrast-enhanced material showed the caval size to be within 3 mm in all 119 patients. In 116 patients (97.5%), CO(2) cavography was judged to be adequate, and in 115 patients, filters were placed. In three (2.5%) patients, it was necessary to perform iodinated contrast-enhanced cavography before filter deployment. All six cases of venous anomaly and 11 (78.6%) of 14 cases of thrombosis were clearly identified with CO(2) cavography. One filter was maldeployed owing to misinterpretation of the CO(2) cavogram.


CONCLUSIONS
CO(2) cavography is well tolerated, safe, and adequate for identification of the parameters necessary for filter deployment. It is especially valuable in patients with a history of reaction to iodinated contrast material or renal insufficiency.
Dewald
C L
CL
Department of Radiology, Division of Vascular and Interventional Radiology, Los Angeles County-University of Southern California Medical Center, CA 90033, USA.
Jensen
C C
CC
Park
Y H
YH
Hanks
S E
SE
Harrell
D S
DS
Peters
G L
GL
Katz
M D
MD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000628:therapy; D011856:Radiographic Image Enhancement; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000628:therapy; D014283:Triiodobenzoic Acids; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D002245:Carbon Dioxide; C054871:ioversol