Journal of Vascular Surgery
Volume 51, Issue 5 , Pages 1215-1221, May 2010

Prospective implementation of an algorithm for bedside intravascular ultrasound-guided filter placement in critically ill patients

Presented at the Twenty-first Annual Meeting of the American Venous Forum, Phoenix, Ariz, Feb 10-14, 2009.

  • Christopher D. Killingsworth, MD

      Affiliations

    • Division of General Surgery, University of Alabama at Birmingham, Birmingham, Ala
    • ,
  • Steven M. Taylor, MD

      Affiliations

    • Sections Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
    • ,
  • Mark A. Patterson, MD

      Affiliations

    • Sections Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
    • ,
  • Jordan A. Weinberg, MD

      Affiliations

    • Trauma, Burns and Surgical Critical Care, University of Alabama at Birmingham, Birmingham, Ala
    • ,
  • Gerald McGwin Jr, MS, PhD

      Affiliations

    • Trauma, Burns and Surgical Critical Care, University of Alabama at Birmingham, Birmingham, Ala
    • ,
  • Sherry M. Melton, MD

      Affiliations

    • Trauma, Burns and Surgical Critical Care, University of Alabama at Birmingham, Birmingham, Ala
    • ,
  • Donald A. Reiff, MD

      Affiliations

    • Trauma, Burns and Surgical Critical Care, University of Alabama at Birmingham, Birmingham, Ala
    • ,
  • Jeffrey D. Kerby, MD

      Affiliations

    • Trauma, Burns and Surgical Critical Care, University of Alabama at Birmingham, Birmingham, Ala
    • ,
  • Loring W. Rue, MD

      Affiliations

    • Trauma, Burns and Surgical Critical Care, University of Alabama at Birmingham, Birmingham, Ala
    • ,
  • William D. Jordan Jr, MD

      Affiliations

    • Sections Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
    • ,
  • Marc A. Passman, MD

      Affiliations

    • Division of General Surgery, University of Alabama at Birmingham, Birmingham, Ala
    • Corresponding Author InformationCorrespondence: Marc A. Passman, MD, Section of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, BDB 503, 1530 3rd Ave South, Birmingham, AL 35294-0012

Received 12 August 2009; accepted 13 December 2009. published online 12 March 2010.

Background

Although contrast venography is the standard imaging method for inferior vena cava (IVC) filter insertion, intravascular ultrasound (IVUS) imaging is a safe and effective option that allows for bedside filter placement and is especially advantageous for immobilized critically ill patients by limiting resource use, risk of transportation, and cost. This study reviewed the effectiveness of a prospectively implemented algorithm for IVUS-guided IVC filter placement in this high-risk population.

Methods

Current evidence-based guidelines were used to create a clinical decision algorithm for IVUS-guided IVC filter placement in critically ill patients. After a defined lead-in phase to allow dissemination of techniques, the algorithm was prospectively implemented on January 1, 2008. Data were collected for 1 year using accepted reporting standards and a quality assurance review performed based on intent-to-treat at 6, 12, and 18 months.

Results

As defined in the prospectively implemented algorithm, 109 patients met criteria for IVUS-directed bedside IVC filter placement. Technical feasibility was 98.1%. Only 2 patients had inadequate IVUS visualization for bedside filter placement and required subsequent placement in the endovascular suite. Technical success, defined as proper deployment in an infrarenal position, was achieved in 104 of the remaining 107 patients (97.2%). The filter was permanent in 21 (19.6%) and retrievable in 86 (80.3%). The single-puncture technique was used in 101 (94.4%), with additional dual access required in 6 (5.6%). Periprocedural complications were rare but included malpositioning requiring retrieval and repositioning in three patients, filter tilt ≥15° in two, and arteriovenous fistula in one. The 30-day mortality rate for the bedside group was 5.5%, with no filter-related deaths.

Conclusions

Successful placement of IVC filters using IVUS-guided imaging at the bedside in critically ill patients can be established through an evidence-based prospectively implemented algorithm, thereby limiting the need for transport in this high-risk population.

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 Competition of interest: none.

 The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.

PII: S0741-5214(09)02638-X

doi:10.1016/j.jvs.2009.12.041

Journal of Vascular Surgery
Volume 51, Issue 5 , Pages 1215-1221, May 2010

Article Tools

* Image Usage & Resolution