title: Comparison of Inferior Vena Cava Filters Placed at the Bedside via Intravenous Ultrasound Guidance Versus Fluoroscopic Guidance.
abstract: BACKGROUND
  IVCFs are usually placed under fluoroscopic guidance in dedicated angiography suites. Bedside placement of inferior vena cava filters (IVCF) is possible in patients not suitable for transportation, but data regarding their use are limited. The objective of this study is to compare utilization, procedural outcomes, complications, and long-term patient outcomes associated with bedside placement of IVCFs using intravascular ultrasound (IVUS) and fluoroscopic placement of IVCF.
  
  
  METHODS
  All patients receiving IVCF between January 2009 and December 2011 at a tertiary care institution were retrospectively identified. Data regarding patient characteristics, IVCF indications, complications, and outcomes were collected, and comparisons were made between patients receiving fluoroscopic-guided and IVUS-guided bedside IVCF.
  
  
  RESULTS
  There were 117 bedside and 571 fluoroscopic-guided IVCF placed during this period. Patients receiving bedside IVCF were younger (50.8 vs. 60.7 years, P < 0.001), less often had malignancy (22.2% vs. 42.6%, P < 0.001), and received prophylactic filters more commonly (59.9% vs. 29.9%, P < 0.001). Placement-related complications occurred in 4.3% and 0.6%, respectively (bedside IVCF: 4 malpositions, 1 severe tilt; fluoroscopic-guided IVCF: 1 malposition, 1 severe tilt, P = 0.01). Indwelling IVCF-related complications occurred equally during median follow-up of 463 and 488 days, respectively (deep vein thrombosis: 13.7% vs. 13.3%, P = 0.92; pulmonary embolism: 5.1% vs. 4.0%, P = 0.61; filter thrombosis: 3.4% vs. 3.9%, P = 0.82). Time to indwelling complication was similar between groups (74 vs. 127 days, P = 0.29).
  
  
  CONCLUSIONS
  Bedside placement of IVUS-guided IVCF is safe, but with higher procedural complications when compared with fluoroscopic placement. Long-term indwelling complications are similar between IVCF placed via bedside IVUS guidance and fluoroscopic approach.
authors: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: sganguli@mgh.harvard.edu.
authors: Suvranu
authors: S
authors: Ganguli
authors: Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
authors: Beau M
authors: BM
authors: Hawkins
authors: Division of Cardiology and Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Farhad
authors: F
authors: Abtahian
authors: Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
authors: Mazen S
authors: MS
authors: Abu-Fadel
authors: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Thomas G
authors: TG
authors: Walker
authors: Division of Cardiology and Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Cheryl
authors: C
authors: MacKay
authors: Division of Cardiology and Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Michael R
authors: MR
authors: Jaff
authors: Division of Cardiology and Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Ido
authors: I
authors: Weinberg
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009825:Oklahoma; D019095:Point-of-Care Systems; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D015641:Radiography, Interventional / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*