EARLY DUPLEX SCAN EVALUATION OF 4 VENA-CAVAL INTERRUPTION DEVICES

Purpose: Transvenous inferior vena cava (IVC) filters are used success fully for prevention of pulmonary embolism (PE), but early thrombotic complications such as insertion site thrombosis (IST) and inferior ven a cava thrombosis (IVCT) may occur after placement. The frequency of t hese complications has been uncertain particularly for the wide variet y of newer devices. This study was performed to prospectively evaluate IST and IVCT with color-flow venous duplex ultrasound scanning after four IVC filters were placed: the birds' nest filter, the titanium Gre enfield filter, the stainless steel GreenfieId filter, and the Simon n itinol filter. Methods: Percutaneous IVC filters were placed in 174 pa tients over a 21-month period. A birds' nest filter was used in 39 (22 %) cases, a titanium Greenfield filter in 67 (39%) cases, a stainless steel GreenfieId filter (25%) in 43 patients, and a Simon nitinol filt er in 25 (14%) cases. Filters were placed for major deep venous thromb osis in 113 (63%) patients, after PE, in 26 (15%) patients, and with p rophylaxis in 35 (20%) patients. All patients had color-flow venous du plex ultrasound scanning of the insertion site and the inferior vena c ava 7 to 10 days after placement or before discharge to document IST o r VCT. Results: Early IST occurred in 43 (24.7%) cases, and early IVCT was observed in 20 (12%) cases in this series. No significant differe nce was found in the incidence of IST or IVCT among the four filter ty pes used. The incidence of IVCT was significantly higher in patients h aving filters placed for PE. Men were more likely to receive a prophyl actic filter than women in this study, but thrombotic complications we re not related to patient sex, Thrombosis was seen with equal frequenc y at all insertion sites used. No patient died of PE after filter plac ement during the study period. Conclusions: The incidence of thromboti c complications for all devices was higher than has generally been rep orted. No IVC filter used in this study demonstrated superior performa nce with regard to these thrombotic complications. As vena cava interr uption devices are developed or significantly modified, prospective ob jective analysis of associated thrombotic complications will allow log ical selection for clinical use.