title: Bedside placement of removable vena cava filters guided by intravascular ultrasound in the critically injured.
abstract: BACKGROUND
  Bedside placement of removable inferior vena cava filters (RVCF) is increasingly used in critically injured patients. The need for fluoroscopic equipment and specialized intensive care unit beds presents major challenges. Intravascular ultrasound (IVUS) eliminates such problems. The objective of the present study was to analyze the safety and feasibility of IVUS-guided bedside RVCF placement in critically injured patients.
  
  
  METHODS
  Between October 2004 and July 2006 47 IVUS-guided RVCF were placed at the bedside. Medical and trauma registry records were reviewed. Primary outcome was RVCF-related complications.
  
  
  RESULTS
  The mean patient age was 41 +/- 19 years, and the mean Injury Severity Score was 30 +/- 12. The right common femoral vein was chosen as the site of access in 40 patients, and the left common femoral vein was the access site in 7 patients. The insertion was performed 3.7 +/- 2.5 days after admission. Four patients (8.5%) developed common femoral deep vein thrombosis (DVT) and three (6%) developed a peripheral pulmonary embolism (PE). Complications related to technique were recorded in two patients (4%) and included one misplacement and one access site bleeding with no further associated morbidity. Five patients died during the hospital stay from issues unrelated to RVCF. Forty-one patients were eligible for follow-up. Removal of RVCF was offered only to 8 patients and was performed successfully in 4 (10%) at a mean of 130 days (range: 44-183 days).
  
  
  CONCLUSIONS
  In this study IVUS-guided bedside placement of RVCF was feasible but was also associated with complications. Follow-up was poor, and the rate of removal disappointingly low, underscoring the need for further exploration of the role of RVCF.
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.forename: Christopher
authors.initials: C
authors.lastname: Kwolek
authors.forename: Alice
authors.initials: A
authors.lastname: Gervasini
authors.forename: Marc
authors.initials: M
authors.lastname: De Moya
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
mesh_terms: D000328:Adult; D003422:Critical Care; D016638:Critical Illness; D020878:Device Removal / Q000706:statistics & numerical data; D005240:Feasibility Studies; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D016306:Vena Cava Filters; D014947:Wounds and Injuries / Q000150:complications*