title: Bedside inferior vena cava filter placement by intravascular ultrasound in critically ill patients is safe and effective for an extended time.
abstract: BACKGROUND
  Bedside inferior vena cava filter (IVCF) placement by intravascular ultrasound (IVUS) guidance has previously been shown to be a safe and effective technique, especially for critically ill patients, with initial experience of a prospectively implemented algorithm. The purpose of this study was to evaluate the effectiveness of IVUS-guided filter placement in critically ill patients with experience now extending out 5 years from implementation.
  
  
  METHODS
  All patients undergoing bedside IVUS-guided IVCF placement from 2008 to 2012 were identified. Records were reviewed on the basis of IVCF reporting standards. Outcomes data including technical success, complications, and mortality were analyzed at 30 days.
  
  
  RESULTS
  During the 5-year period, 398 patients underwent attempted bedside IVCF placement by IVUS. Technical feasibility was possible in 396 cases (99.5%); two bedside procedures were aborted because of inadequate IVUS visualization. Overall technical success was achieved in 393 of 396 (99.2%), with malpositioned IVCF in three cases. An optional IVCF was used in 372 (93.9%) and a permanent IVCF in 24 (6.1%). Single-puncture technique was performed in 388 (97.4%); additional dual access was required in 10 (2.6%). Periprocedural complications were rare (3.0%) and included malpositioning that required retrieval and repositioning or an additional IVCF (3), filter tilt ≥20 degrees (4), arteriovenous fistulas (2), insertion site thrombosis (2), and hematoma (1). Comparison of the first 100 procedures performed within the sample population with the last 100 procedures revealed an overall success rate of 96% in the first 100 compared with 100% in the last 100 (P = .043). There were no deaths related to pulmonary embolism or IVCF-related problems.
  
  
  CONCLUSIONS
  On the basis of 5 years of experience with bedside IVCF placement in critically ill patients, the IVUS-guided IVCF technique continues to be a safe and effective option in this high-risk population, with a time-dependent improvement in outcome measures.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Roan J
authors.initials: RJ
authors.lastname: Glocker
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Oluwafunmi
authors.initials: O
authors.lastname: Awonuga
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Novak
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Pearce
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Mark
authors.initials: M
authors.lastname: Patterson
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Matthews
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala.
authors.forename: William D
authors.initials: WD
authors.lastname: Jordan
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala. Electronic address: mpassman@uabmc.edu.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Passman