Duplex scan-directed placement of inferior vena cava filters: a five-year institutional experience.
OBJECTIVE
The purpose of this study was the assessment of the safety, efficacy, and hospital charges of bedside duplex ultrasound-directed inferior vena cava (IVC) filter placement.


METHODS
All duplex ultrasound-directed IVC filters that were placed from August 8, 1995, to December 31, 2000, are reviewed. Chart review combined with mailed questionnaires and telephone follow-up examinations were used to collect demographic and outcome data.


RESULTS
Three hundred twenty-five patients underwent evaluation, and 284 underwent duplex ultrasound-directed IVC filter placement. Two hundred three (71%) were male patients, and 81 (29%) were female patients. Poor IVC visualization, IVC thrombosis, and unsuitable anatomy prevented duplex-directed filter placement in 41 patients (12%). Indication for filter placement included venous prophylaxis in the absence of thromboembolism in 235 patients (83%), contraindication to anticoagulation therapy in 34 patients (12%), prophylaxis with therapeutic anticoagulation therapy in the presence of thromboembolism in 7 patients (2%), and complication of anticoagulation therapy in 8 patients (3%). There were no procedure-related deaths or septic complications. Technical complications occurred in 12 patients (4%). Filter misplacement occurred in 6 patients (2%), access thrombosis in 1 (<1%), migration in 1 (<1%), bleeding in 1 (<1%), and IVC occlusion in 3 (1%). Pulmonary emboli after IVC filter placement occurred in one patient with a misplaced filter. Average hospital charges related to duplex ultrasound-directed filter placement were $2388 less than fluoroscopic placement charges in the year 2000.


CONCLUSIONS
Our experience indicates that duplex ultrasound-directed IVC filter placement is safe, cost-effective, and convenient for patients who need IVC filter placement.
Conners
Michael S
MS
Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2725, USA.
Becker
Stacey
S
Guzman
Raul J
RJ
Passman
Marc A
MA
Pierce
Rosanna
R
Kelly
Tina
T
Naslund
Thomas C
TC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis / Q000191:economics; D004869:Equipment Safety; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000473:pathology; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control; D016019:Survival Analysis; D013714:Tennessee / Q000453:epidemiology; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics / Q000295:instrumentation*; D016306:Vena Cava Filters / Q000191:economics / Q000592:standards