title: Placement of the VenaTech LP caval filter in the elderly: feasibility and clinical benefits of insertion via the arm.
abstract: OBJECTIVE
  To evaluate routine use of access sites in the arm for percutaneous caval filter placement (PCFP) in elderly patients. Neck arthritis, patient anxiety, access site thrombosis or fecal/urinary incontinence complicating jugular or femoral access may require alternative access sites in this population.
  
  
  METHODS
  Access via the right arm was chosen for PCFP (VenaTech LP). The indication for PCFP was deep vein thrombosis, a history of pulmonary embolism, and a contraindication to anticoagulant therapy. Ultrasound-guided puncture was performed after diameter measurement of the arm veins (ØAV). The filter was inserted with standard imaging procedures. Procedural difficulty was graded and compared with ØAV and the angle from the arm vein to the superior vena cava (alphaAV/SVC).
  
  
  RESULTS
  Over 2 years, 16 patients (14 women, 2 men) with an average age of 90 years (range 79-97 years) were included in the study. The average ØAV value of the basilic or brachial veins was 4.2 mm (range 3.0-5.1 mm). The minimal ØAV for successful access was determined after the first 15 patients. No hematoma occurred at the puncture sites. The average alphaAV/SVC value was 62 degrees (range 29 degrees -90 degrees ). Arm access was possible in 12 of 16 patients (75%) with ØAV >or= 3.5 mm and alphaAV/SVC >or= 29 degrees . Every procedure via the arm was graded "easy" by the operator, regardless of angulation values. Femoral access was used in one case due to the impossibility of traversing the heart (patient no. 2), and jugular access was used in 3 of 16 (19%) patients due to puncture failure (patient no. 4), small ØAV (3 mm) (patient no. 6), and stenosis of the distal right subclavian vein (patient no.16), respectively.
  
  
  CONCLUSIONS
  PCFP via the arm can be routinely accomplished in patients older than 75 years, provided ØAV >or= 3.5 mm, and alphaAV/SVC >or= 29 degrees .
authors: Department of Radiology and Medical Imaging, Hôpital , Universitaire Charles Foix - Assistance Publique - Hôpitaux de Paris, Université de Paris , 6-7, avenue de la République, 94205 Ivry-sur-Seine Cedex, France. le_blanche.alain@chu-amiens.fr
authors: Alain F
authors: AF
authors: Le Blanche
authors: Eric
authors: E
authors: Pautas
authors: Isabelle
authors: I
authors: Gouin
authors: Audrey
authors: A
authors: Bagüés
authors: François
authors: F
authors: Piette
authors: Pascal
authors: P
authors: Chaibi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000000981:diagnostic imaging / Q000601:surgery*; D001367:Axillary Vein / Q000000981:diagnostic imaging / Q000601:surgery; D003287:Contrast Media / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D018084:Ultrasonography, Interventional / Q000379:methods; D016306:Vena Cava Filters / Q000009:adverse effects; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*
chemical_list: D003287:Contrast Media; D007472:Iohexol