Bedside IVC filter placement safe in critically ill

PALM BEACH, FLA. – Bedside vena cava filter placement using intravascular ultrasound was a safe and effective option in critically ill patients, according to a retrospective study at the University of Alabama at Birmingham.

During a 5-year period, 98% of the filter placements were successful. Technical success also improved significantly, and the complication rates dropped, reported Dr. Roan J. Glocker during a presentation at the annual meeting of the Southern Association for Vascular Surgery.

Vena cava filters have been used for nearly 4 decades for the prevention of pulmonary embolism. Dr. Glocker said that the bedside methods of filter placement often eliminate the need to transport patients, who are often critically ill or injured. It also eliminates the need for an operating room or angiography usage and reduces the risk that may result from contrast administration and radiation.

In 2010, researchers at the University of Alabama first reported successful outcomes of an algorithm for bedside intravascular ultrasound (IVUS) guided inferior vena cava (IVC) filter placement. Dr. Glocker said that the team wanted to evaluate their experience over a longer period of time, and to determine whether the safety and efficacy of the procedure was sustainable and evaluate the complication rates.

Researchers conducted a retrospective review of 398 patients undergoing bedside IVUS-guided IVC filter placement from 2008 to 2012. Seventy-percent of the patients were male, with a mean age of 77 years old, ranging from 14 to 91 years old. Close to 80% were multitrauma patients. The most common indication for filter placement was VTE prophylaxis in multisystem injury.

Outcomes were analyzed at 30 days. The study had no control groups.

Results showed that the technical success was 98%. The optional filters – Gunther Tulip or Cook Celect – were used in 94% of the patients, and the Greenfield permanent filter was used in the rest.

In 97% of the cases, a single puncture technique was performed. Periprocedural complications occurred only 3% of the time. Thirty patients died within 30 days of filter placement; however, there were no deaths related to pulmonary embolism or filter-related problems, Dr. Glocker reported.

When researchers compared the first and last 100 procedures, the complication rates dropped from 7% to 2 % (P = .08), and the technical success improved significantly from 96% in the first 100 procedures to 100% in the last 100.

Although there has been little change in the basic design of the filters, there have been remarkable improvements in placement techniques, going from the operating room to the radiology suites, to the patient bedside, said Dr. Lazar J. Greenfield Sr., professor emeritus of surgery at the University of Michigan, Ann Arbor, and the inventor of the filter.

But a 2013 study showed that the use of vena cava filters varies widely among hospitals, and some experts say that there’s still not enough evidence about its effectiveness.

In 2010, the Food and Drug Administration issued safety concerns about leaving the filters in place for a long period of time. Currently, the PRESERVE (Predicting the Safety and Effectiveness of Inferior Vena Cava Filters) study, a 5-year, multispecialty, prospective trial, is examining the use of IVC filters by focusing on safety endpoints.

The procedure has a learning curve. The surgeon has to be familiar with the IVUS modality and should have a thorough understanding of deployment of each filter, Dr. Glocker said. He guesstimated that physicians should perform approximately 20-50 procedures to reach competency and start performing the procedure on their own.

Dr. Glocker and Dr. Greenfield had no disclosures.

nmiller@frontlinemedcom.com

On Twitter @naseemsmiller

PALM BEACH, FLA. – Bedside vena cava filter placement using intravascular ultrasound was a safe and effective option in critically ill patients, according to a retrospective study at the University of Alabama at Birmingham.

During a 5-year period, 98% of the filter placements were successful. Technical success also improved significantly, and the complication rates dropped, reported Dr. Roan J. Glocker during a presentation at the annual meeting of the Southern Association for Vascular Surgery.

Vena cava filters have been used for nearly 4 decades for the prevention of pulmonary embolism. Dr. Glocker said that the bedside methods of filter placement often eliminate the need to transport patients, who are often critically ill or injured. It also eliminates the need for an operating room or angiography usage and reduces the risk that may result from contrast administration and radiation.

In 2010, researchers at the University of Alabama first reported successful outcomes of an algorithm for bedside intravascular ultrasound (IVUS) guided inferior vena cava (IVC) filter placement. Dr. Glocker said that the team wanted to evaluate their experience over a longer period of time, and to determine whether the safety and efficacy of the procedure was sustainable and evaluate the complication rates.

Researchers conducted a retrospective review of 398 patients undergoing bedside IVUS-guided IVC filter placement from 2008 to 2012. Seventy-percent of the patients were male, with a mean age of 77 years old, ranging from 14 to 91 years old. Close to 80% were multitrauma patients. The most common indication for filter placement was VTE prophylaxis in multisystem injury.

Outcomes were analyzed at 30 days. The study had no control groups.

Results showed that the technical success was 98%. The optional filters – Gunther Tulip or Cook Celect – were used in 94% of the patients, and the Greenfield permanent filter was used in the rest.

In 97% of the cases, a single puncture technique was performed. Periprocedural complications occurred only 3% of the time. Thirty patients died within 30 days of filter placement; however, there were no deaths related to pulmonary embolism or filter-related problems, Dr. Glocker reported.

When researchers compared the first and last 100 procedures, the complication rates dropped from 7% to 2 % (P = .08), and the technical success improved significantly from 96% in the first 100 procedures to 100% in the last 100.

Although there has been little change in the basic design of the filters, there have been remarkable improvements in placement techniques, going from the operating room to the radiology suites, to the patient bedside, said Dr. Lazar J. Greenfield Sr., professor emeritus of surgery at the University of Michigan, Ann Arbor, and the inventor of the filter.

But a 2013 study showed that the use of vena cava filters varies widely among hospitals, and some experts say that there’s still not enough evidence about its effectiveness.

In 2010, the Food and Drug Administration issued safety concerns about leaving the filters in place for a long period of time. Currently, the PRESERVE (Predicting the Safety and Effectiveness of Inferior Vena Cava Filters) study, a 5-year, multispecialty, prospective trial, is examining the use of IVC filters by focusing on safety endpoints.

The procedure has a learning curve. The surgeon has to be familiar with the IVUS modality and should have a thorough understanding of deployment of each filter, Dr. Glocker said. He guesstimated that physicians should perform approximately 20-50 procedures to reach competency and start performing the procedure on their own.

Dr. Glocker and Dr. Greenfield had no disclosures.

nmiller@frontlinemedcom.com

On Twitter @naseemsmiller

PALM BEACH, FLA. – Bedside vena cava filter placement using intravascular ultrasound was a safe and effective option in critically ill patients, according to a retrospective study at the University of Alabama at Birmingham.

During a 5-year period, 98% of the filter placements were successful. Technical success also improved significantly, and the complication rates dropped, reported Dr. Roan J. Glocker during a presentation at the annual meeting of the Southern Association for Vascular Surgery.

Vena cava filters have been used for nearly 4 decades for the prevention of pulmonary embolism. Dr. Glocker said that the bedside methods of filter placement often eliminate the need to transport patients, who are often critically ill or injured. It also eliminates the need for an operating room or angiography usage and reduces the risk that may result from contrast administration and radiation.

In 2010, researchers at the University of Alabama first reported successful outcomes of an algorithm for bedside intravascular ultrasound (IVUS) guided inferior vena cava (IVC) filter placement. Dr. Glocker said that the team wanted to evaluate their experience over a longer period of time, and to determine whether the safety and efficacy of the procedure was sustainable and evaluate the complication rates.

Researchers conducted a retrospective review of 398 patients undergoing bedside IVUS-guided IVC filter placement from 2008 to 2012. Seventy-percent of the patients were male, with a mean age of 77 years old, ranging from 14 to 91 years old. Close to 80% were multitrauma patients. The most common indication for filter placement was VTE prophylaxis in multisystem injury.

Outcomes were analyzed at 30 days. The study had no control groups.

Results showed that the technical success was 98%. The optional filters – Gunther Tulip or Cook Celect – were used in 94% of the patients, and the Greenfield permanent filter was used in the rest.

In 97% of the cases, a single puncture technique was performed. Periprocedural complications occurred only 3% of the time. Thirty patients died within 30 days of filter placement; however, there were no deaths related to pulmonary embolism or filter-related problems, Dr. Glocker reported.

When researchers compared the first and last 100 procedures, the complication rates dropped from 7% to 2 % (P = .08), and the technical success improved significantly from 96% in the first 100 procedures to 100% in the last 100.

Although there has been little change in the basic design of the filters, there have been remarkable improvements in placement techniques, going from the operating room to the radiology suites, to the patient bedside, said Dr. Lazar J. Greenfield Sr., professor emeritus of surgery at the University of Michigan, Ann Arbor, and the inventor of the filter.

But a 2013 study showed that the use of vena cava filters varies widely among hospitals, and some experts say that there’s still not enough evidence about its effectiveness.

In 2010, the Food and Drug Administration issued safety concerns about leaving the filters in place for a long period of time. Currently, the PRESERVE (Predicting the Safety and Effectiveness of Inferior Vena Cava Filters) study, a 5-year, multispecialty, prospective trial, is examining the use of IVC filters by focusing on safety endpoints.

The procedure has a learning curve. The surgeon has to be familiar with the IVUS modality and should have a thorough understanding of deployment of each filter, Dr. Glocker said. He guesstimated that physicians should perform approximately 20-50 procedures to reach competency and start performing the procedure on their own.

Dr. Glocker and Dr. Greenfield had no disclosures.

nmiller@frontlinemedcom.com

On Twitter @naseemsmiller