Günther Tulip and Celect IVC filters in multiple-trauma patients.
OBJECTIVE
To evaluate results with the retrievable Günther Tulip (GT) and Celect inferior vena cava filters (IVCFs) placed at the intensive care unit (ICU) bedside under "real-time" intravascular ultrasound (IVUS) guidance in multiple-trauma patients.


METHODS
Between December 2004 and December 2008, 187 multiple-trauma patients (109 men; mean age 44+/-2 years, range 17-71) with contraindications to low-dose anticoagulation therapy or sequential compression devices had Günther Tulip (n = 97) or Celect (n = 90) retrievable IVCFs placed under real-time IVUS guidance. Günther Tulip filters were inserted using a "double-puncture" technique. The Celect IVCFs were placed with a simplified single-puncture technique in which the filter introducer sheath was advanced until the radiopaque tip "covered" the IVUS image of the renal vein, indicating that the filter sheath was in position for filter deployment. The 2 filter groups were compared on the endpoints of technical implantation success, retrievability, prevention of PE, and procedure-related deep vein thrombosis (DVT).


RESULTS
As verified by abdominal radiography, 93.1% (174/187) of IVCFs were placed without complications; 6 IVCFs (all GT; p = 0.03 versus Celect) were misplaced in the iliac vein but uneventfully retrieved and replaced in the IVC within 24 hours. Two insertion site femoral vein DVTs (both in the dual puncture group; p>0.2) and 5 groin hematomas occurred during follow-up. GT filters were in place a mean of 107 days and Celect 97 days. In this time, 2 pulmonary embolisms occurred (1 in each group; p>0.2). Of the 115 filters scheduled for retrieval (50 Günther Tulip, 65 Celect), 33 (23 Günther Tulip, 10 Celect) could not be retrieved (p = 0.0004). Vena cavography identified filter tilting (>20 degrees ) in 21 cases (15 GT, 6 Celect), while 12 filters (8 GT, 4 Celect) had extended indwell times (mean 187 days) and excessive tissue ingrowth covering the retrieval hook. Subjectively, the Celect filters were clinically "easier" to retrieve; they also had fewer cases of significant tilt (>20%) than the GT filters, but the difference was not statistically significant.


CONCLUSIONS
GT and Celect IVCFs placed at the ICU bedside under IVUS guidance in multiple-trauma patients was simple, safe, and avoided transporting critically ill patients out of the ICU. Further investigation of the single sheath IVUS technique and the role of retrievable IVCFs in multi-trauma patients is warranted.
Rosenthal
David
D
Department of Vascular Surgery, Atlanta Medical Center, Atlanta, Georgia, USA. docro@mindspring.com
Kochupura
Paul V
PV
Wellons
Eric D
ED
Burkett
Allison B
AB
Methodius-Rayford
Walaya C
WC
D000293:Adolescent; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D003422:Critical Care; D016638:Critical Illness; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D010690:Phlebography; D019095:Point-of-Care Systems; D011474:Prosthesis Design; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D011677:Punctures; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D055815:Young Adult