RADIOLOGIC VERSUS SURGICAL PLACEMENT OF VENA-CAVA FILTERS - A COMPARATIVE-STUDY OF COST, TIME AND COMPLICATIONS

Objective: To compare the cost-and time-effectiveness of 2 methods of placement of vena cava filters for the prevention of pulmonary embolis m: the radiologic percutaneous placement of the Vena Tech LGM filter a nd the surgical cutdown placement of the 24 Fr Greenfield filter. Meth ods: Retrospective review of radiologic and clinical records for 15 co nsecutive patients who had the Vena Tech LGM filter placed radiologica lly and 15 consecutive patients who had the Greenfield filter placed s urgically. Factors studied were cost, procedure time, waiting time and rates of immediate and delayed complications. The follow-up period ra nged from 1 to 26 months (mean 7 months). Results: The procedure cost for the radiologic method was $702 less than for the surgical method. The procedure time for the radiologic method was 30 minutes shorter, a nd the waiting time for placement was also shorter. There was no diffe rence in the complication rates following each procedure. The higher c ost of the Greenfield filter accounted for 80% of the total cost diffe rence. Conclusion: The radiologic percutaneous method of filter placem ent is preferred over the surgical cutdown method because of its benef its in terms of cost and time with no increase in risk. However, when the difference in cost between filters is taken into account, there is little difference in overall costs for the 2 methods. Therefore, radi ology and surgery departments can place a filter percutaneously at a s imilar cost. Other factors such as waiting times, complication rates, venography capabilities and physician interest in performing the proce dure will dictate which department places the filter.