Bedside Placement of Removable Vena Cava Filters Guided by Intravascular Ultrasound in the Critically Injured
Konstantinos Spaniolas
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
Search for more papers by this authorCorresponding Author
George C. Velmahos
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
[email protected]Search for more papers by this authorChristopher Kwolek
Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
Search for more papers by this authorAlice Gervasini
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
Search for more papers by this authorMarc De Moya
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
Search for more papers by this authorHasan B. Alam
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
Search for more papers by this authorKonstantinos Spaniolas
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
Search for more papers by this authorCorresponding Author
George C. Velmahos
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
[email protected]Search for more papers by this authorChristopher Kwolek
Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
Search for more papers by this authorAlice Gervasini
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
Search for more papers by this authorMarc De Moya
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
Search for more papers by this authorHasan B. Alam
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, 02114 Boston, MA, USA
Search for more papers by this authorAbstract
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.
References
- 1NeuerburgJM, GüntherRW, VorwerkD et al. Results of a multicenter study of the retrievable Tulip vena cava filter: early clinical experience. Cardiovasc Intervent Radiol (1997) 20: 10–16899471810.1007/s002709900102
- 2BovynG, GoryP, ReynaudP et al. The Tempofilter: a multicenter study of a new temporary caval filter implantable for up to six weeks. Ann Vasc Surg (1997) 11: 520–528930206510.1007/s100169900084
- 3Van NattaTL, MorrisJA, EddyVA et al. Elective bedside surgery in critically injured patients is safe and cost-effective. Ann Surg (1998) 227: 618–624960565310.1097/00000658-199805000-00002
- 4FriedmanY, FildesJ, MizockB et al. Comparison of percutaneous and surgical tracheostomies. Chest (1996) 110: 480–485869785410.1378/chest.110.2.480
- 5SingRF, SmithCH, MilesWS et al. Preliminary results of bedside inferior vena cava filter placement: safe and cost-effective. Chest (1998) 114: 315–316967448610.1378/chest.114.1.315
- 6RogersFB, ShackfordSR, WilsonJ et al. Prophylactic vena cava filter insertion in severely injured trauma patients: indications and preliminary results. J Trauma (1993) 35: 637–6418411290
- 7JoelsCS, SingRF, HenifordBT Complications of inferior vena cava filters. Am Surg (2003) 69: 654–65912953821
- 8SavinMA, PanickerHK, SadiqS et al. Placement of vena cava filters: factors affecting technical success and immediate complications. AJR Am J Roentgenol (2002) 179: 597–60212185026
- 9GinzburgE, CohnSM, LopezJ et al. Miami Deep Vein Thrombosis Study Group. Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma. Br J Surg (2003) 90: 1338–13441459841110.1002/bjs.4309
- 10GeertsWH, CodeKI, JayRM et al. A prospective study of venous thromboembolism after major trauma. N Engl J Med (1994) 331: 1601–1606796934010.1056/NEJM199412153312401
- 11 Spinal Cord Injury Thromboprophylaxis InvestigatorsPrevention of venous thromboembolism in the acute treatment phase after spinal cord injury: a randomized, multicenter trial comparing low-dose heparin plus intermittent pneumatic compression with enoxaparin. J Trauma (2003) 54: 1116–112410.1097/01.TA.0000066385.10596.71
- 12AcostaJA, YangJC, WinchellRJ et al. Lethal injuries and time to death in a level I trauma center. J Am Coll Surg (1998) 186: 528–533958369210.1016/S1072-7515(98)00082-9
- 13 for the Prévention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med (1998) 338: 409–415
- 14Study GroupPREPIC Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation (2005) 112: 416–42210.1161/CIRCULATIONAHA.104.512834
- 15RogersFB, ShackfordSR, RicciMA et al. Routine prophylactic vena cava filter insertion in severely injured trauma patients decreases the incidence of pulmonary embolism. J Am Coll Surg (1995) 180: 641–6477773475
- 16RodriguezJL, LopezJM, ProctorMC et al. Early placement of prophylactic vena caval filters in injured patients at high risk for pulmonary embolism. J Trauma (1996) 40: 797–8028614083
- 17KhansariniaS, DennisJW, VeldenzHC et al. Prophylactic Greenfield filter placement in selected high-risk trauma patients. J Vasc Surg (1995) 22: 231–235767446510.1016/S0741-5214(95)70135-4
- 18McMurtryAL, OwingsJT, AndersonJT et al. Increased use of prophylactic vena cava filters in trauma patients failed to decrease overall incidence of pulmonary embolism. J Am Coll Surg (1999) 189: 314–3201047293310.1016/S1072-7515(99)00137-4
- 19RosenthalD, McKinseyJF, LevyAM et al. Use of the Greenfield filter in patients with major trauma. Cardiovasc Surg (1994) 2: 52–558049925
- 20RosenthalD, WellonsED, LaiKM et al. Retrievable inferior vena cava filters: initial clinical results. Ann Vasc Surg (2006) 20: 157–1651637814110.1007/s10016-005-9390-z
- 21GarrettJV, PassmanMA, GuzmanRJ et al. Expanding options for bedside placement of inferior vena cava filters with intravascular ultrasound when transabdominal duplex ultrasound imaging is inadequate. Ann Vasc Surg (2004) 18: 329–3341535463510.1007/s10016-004-0029-2
- 22EbaughJL, ChiouAC, MoraschMD et al. Bedside vena cava filter placement guided with intravascular ultrasound. J Vasc Surg (2001) 34: 21–261143607010.1067/mva.2001.115599
- 23RogersFB, StrindbergG, ShackfordSR et al. Five-year follow-up of prophylactic vena cava filters in high-risk trauma patients. Arch Surg (1998) 133: 406–411956512110.1001/archsurg.133.4.406
- 24 for the European Tempofilter II Study GroupLong-duration temporary vena cava filter: a prospective 104-case multicenter study. J Vasc Surg (2006) 43: 1222–1229
- 25BinkertCA, SasadeuszK, StavropoulosSW Retrievability of the recovery vena cava filter after dwell times longer than 180 days. J Vasc Interv Radiol (2006) 17: 299–3021651777510.1097/01.RVI.0000195153.32491.37
- 26IndeckM, PetersonS, SmithJ et al. Risk, cost, and benefit of transporting ICU patients for special studies. J Trauma (1988) 28: 1020–10253135417
- 27BramanSS, DunnSM, AmicoCA et al. Complications of intrahospital transport in critically ill patients. Ann Intern Med (1987) 107: 469–4733477105
- 28SmithI, FlemingS, CernaianuA Mishaps during transport from the intensive care unit. Crit Care Med (1990) 18: 278–281230295210.1097/00003246-199012001-00198
- 29NunnCR, NeuzilD, NaslundT et al. Cost-effective method for bedside insertion of vena caval filters in trauma patients. J Trauma (1997) 43: 752–758939048510.1097/00005373-199711000-00004
- 30BonnJ, LiuJB, EschelmanDJ et al. Intravascular ultrasound as an alternative to positive-contrast vena cavography prior to filter placement. J Vasc Interv Radiol (1999) 10: 843–84910435700
- 31RosenthalD, WellonsED, LaiKM et al. Retrievable inferior vena cava filters: early clinical experience. J Cardiovasc Surg (Torino) (2005) 46: 163–169
- 32RosenthalD, WellonsED, LevittAB et al. Role of prophylactic temporary inferior vena cava filters placed at the ICU bedside under intravascular ultrasound guidance in patients with multiple trauma. J Vasc Surg (2004) 40: 958–9641555791110.1016/j.jvs.2004.07.048
- 33WellonsED, RosenthalD, ShulerFW et al. Real-time intravascular ultrasound-guided placement of a removable inferior vena cava filter. J Trauma (2004) 57: 20–2315284542
- 34AshleyDW, GamblinTC, McCampbellBL et al. Bedside insertion of vena cava filters in the intensive care unit using intravascular ultrasound to locate renal veins. J Trauma (2004) 57: 26–311528454310.1097/01.TA.0000133626.75366.83
- 35WellonsED, MatsuuraJH, ShulerFW et al. Bedside intravascular ultrasound-guided vena cava filter placement. J Vasc Surg (2003) 38: 455–4571294725310.1016/S0741-5214(03)00471-3
- 36OppatWF, ChiouAC, MatsumuraJS Intravascular ultrasound-guided vena cava filter placement. J Endovasc Surg (1999) 6: 285–2871049515810.1583/1074-6218(1999)006<0285:IUVCFP>2.0.CO;2
- 37TolaJC, HoltzmanR, LottenbergL Bedside placement of inferior vena cava filters in the intensive care unit. Am Surg (1999) 65: 833–83710484085discussion 837–838
- 38VassiliuP, SavaJ, ToutouzasKG et al. Is contrast as bad as we think? Renal function after angiographic embolization of injured patients. J Am Coll Surg (2002) 194: 142–1461184863110.1016/S1072-7515(01)01138-3
- 39HoffWS, HoeyBA, WainwrightGA et al. Early experience with retrievable inferior vena cava filters in high-risk trauma patients. J Am Coll Surg (2004) 199: 869–8741555596910.1016/j.jamcollsurg.2004.07.030
- 40StefanidisD, PatonBL, JacobsDG et al. Extended interval for retrieval of vena cava filters is safe and may maximize protection against pulmonary embolism. Am J Surg (2006) 192: 789–7941716109510.1016/j.amjsurg.2006.08.046
- 41DuperierT, MosenthalA, SwanKG et al. Acute complications associated with greenfield filter insertion in high-risk trauma patients. J Trauma (2003) 54: 545–5491263453610.1097/00005373-200303000-00018
- 42WojcikR, CipolleMD, FearenI et al. Long-term follow-up of trauma patients with a vena caval filter. J Trauma (2000) 49: 839–84311086773
- 43AllenTL, CarterJL, MorrisBJ et al. Retrievable vena cava filters in trauma patients for high-risk prophylaxis and prevention of pulmonary embolism. Am J Surg (2005) 189: 656–6611591071510.1016/j.amjsurg.2005.03.003
- 44AntevilJL, SiseMJ, SackDI et al. Retrievable vena cava filters for preventing pulmonary embolism in trauma patients: a cautionary tale. J Trauma (2006) 60: 35–4016456434
- 45KirilcukNN, HergetEJ, DickerRA et al. Are temporary inferior vena cava filters really temporary?. Am J Surg (2005) 190: 858–8631630793410.1016/j.amjsurg.2005.08.009
- 46MorrisCS, RogersFB, NajarianKE et al. Current trends in vena caval filtration with the introduction of a retrievable filter at a level I trauma center. J Trauma (2004) 57: 32–3615284544
- 47GrandeWJ, TrerotolaSO, ReillyPM et al. Experience with the recovery filter as a retrievable inferior vena cava filter. J Vasc Interv Radiol (2005) 16: 1189–119316151059
- 48Karmy-JonesR, JurkovichGJ, VelmahosGC et al. Practice patterns and outcomes of retrievable vena cava filters in trauma patients: an AAST multicenter study. J Trauma (2007) 62: 17–2517215729
