1 / 23

Ultrasound Placement of Vena Cava Filters

Ultrasound Placement of Vena Cava Filters. Thomas Naslund Vanderbilt University Medical Center. CONFLICT OF INTERESTS. WL Gore Consultant Boston Scientific Consultant LeMaitre Vascular Scientific Advisory Board. Greenfield Filter. Introduced 35 years ago

eydie
Download Presentation

Ultrasound Placement of Vena Cava Filters

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ultrasound Placement of Vena Cava Filters Thomas Naslund Vanderbilt University Medical Center

  2. CONFLICT OF INTERESTS WL Gore Consultant Boston Scientific Consultant LeMaitre Vascular Scientific Advisory Board

  3. Greenfield Filter • Introduced 35 years ago • Excellent safety and efficacy • Integral component of venous thromboembolism (VTE) • Initially performed in OR with cutdown • Routinely performed percutaneously - angio suites • Bedside placement with ultrasound

  4. Filters for Ultrasound Placement • Greenfield, Cook Tulip, Simon Nitinol – well suited to ultrasound placement • Greenfield visualized well out of sheath • Tulip best visualized while in sheath

  5. Indications for Filter

  6. Ultrasound Placement • Initiated in 1995 • Adaptable to bedside placement • Surface or IVUS can be utilized • Eliminates patient transport • Reduced institutional cost • Efficient use of physician time

  7. Technique Filter Placement with Surface Ultrasound • Preliminary duplex of femoral vein & IVC • Identify thrombus, diameter, landmarks • Establish femoral access/identify wire in IVC • Routine sheath placement/visualization • Position filter tip at right renal vein (remove wire) and deploy • Completion KUB

  8. Technique Filter Placement with Surface Ultrasound • Preliminary duplex of femoral vein & IVC • Identify thrombus, diameter, landmarks

  9. Technique IVUSDual Access • Duplex femoral veins-optional • Dual femoral access (preferred bilateral) • Visualize sheath and iliac vein confluence • Advance to atrium • “Pull back” visualization/IVC diameter • Position filter tip at renal vein • Pull IVUS back and deploy • Advance IVUS to evaluate filter • Completion KUB

  10. Technique IVUSsingle access • Interrogate atrium to iliacs (using filter sheath) • Mark location of renal vein on catheter (tie) • Translate mark onto the filter delivery catheter • Insert to mark to deploy blind • Advance IVUS to check deployment • Completion KUB

  11. Series of Ultrasound Guided Filter Placement DUS, duplex ultrasound. IVUS, intravascular ultrasound. OR, operating room. IR, interventional radiology.

  12. Safety ConsiderationsAvoiding Patient Transport • Invasive monitoring lines • Pressors • Ventilators • Drains • Transportation complications risk up to 15.5%

  13. Misplacement • Most common 0-8% • Iliac vein or suprarenal IVC • Often attributed to poor visualization or U/S misinterpretation • Suprarenal placement is satisfactory • Iliac requires fluoroscopic filter repositioning

  14. Insertion Site Thrombosis • Occurs in up to 16.7% of patients • Double venous puncture technique increases exposure to risk • Incidence is related to surveillance of access site • With routine surveillance, IST may occur in up to one third of patients

  15. Financial ConsiderationsCost Reduction • Avoid patient transport • No interventional suite • Over $2000 cost reduction per patient (2002)

  16. Comparison of Techniques *unless single puncture technique used DUS, duplex ultrasonography. IVUS, intravascular ultrasound.

More Related