Retrievable inferior vena cava filters: early clinical experience.
OBJECTIVE
Multiple-trauma patients often have injuries that prevent the use of anticoagulant or sequential compression device prophylaxis. Temporary inferior vena cava filters (IVCFs) offer protection against pulmonary embolism (PE) during the early, highest-risk perioperative and immediate injury period, while avoiding potential long-term sequelae of a permanent IVCF. The objective of this study was to evaluate the efficacy of prophylactic, temporary IVCF placement at the intensive care unit (ICU) bedside under real-time intravascular ultrasound (IVUS) guidance in multiple-trauma patients.


METHODS
One hundred and three multiple-trauma patients between July 1, 2002, and July 1, 2004, under-went placement of Günther-Tulip (n=38), Recovery (n=30) or OptEase (n=35) retrievable IVCFs under real-time IVUS guidance. The mean+/-SD injury severity score of the patients was 27.7 (+/-2.2). All patients had abdominal X-rays to verify filter location. Before IVCF retrieval, all patients underwent femoral vein color-flow ultrasonography to rule out deep vein thrombosis (DVT) and pre and postprocedure vena-cavography for possible IVCF thrombus entrapment and postretrieval IVC injury.


RESULTS
Twenty-four patients died of their injuries; no deaths were related to IVCF placement. One PE occurred during follow-up after filter retrieval, and 2 insertion site femoral vein DVT occurred. As verified by abdominal X-rays, 97.1% (100/103) of IVCFs were placed without complications at the L2-3 level. Filter-related complications included 3 groin hematomas (2.9%) and 3 IVCFs misplaced in the right iliac vein early in our experience; these filters were uneventfully retrieved and replaced in the IVC within 24 h. Forty-four patients underwent uneventful retrieval of IVCFs after DVT or PE anticoagulation prophylaxis was initiated. Thirty-five filters were not removed, including 32 because severity of injury prevented DVT or PE prophylaxis and 3 because of thrombus trapped with the filter.


CONCLUSIONS
Prophylactic, temporary IVCFs placed at the ICU bedside under IVUS guidance in multiple-trauma patients serves as an effective bridge to anticoagulation until venous thromboembolism prophylaxis can be initiated. Further investigation of this bedside technique and the role of temporary IVCFs in these patients is warranted.
Rosenthal
D
D
Department of Vascular Sugery, Atlanta Medical Center, Atlanta, GA, USA. docro@mindspring.com
Wellons
E D
ED
Lai
K M
KM
Bikk
A
A
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D020878:Device Removal; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional; D014654:Vascular Patency; D016306:Vena Cava Filters / Q000009:adverse effects; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control