CLINICAL-EXPERIENCE WITH THE ANTECUBITAL SIMON NITINOL IVC FILTER

PURPOSE: To evaluate the Simon nitinol vena cava filter (SNF) placed v ia the antecubital vein in a series of patients, Issues examined by th e authors included insertion site variables, filter efficacy, and comp lications. The authors also explored the option of placement of a peri pherally inserted central catheter (PICC) via the same access site. MA TERIALS AND METHODS: This was a prospective study that included all pa tients who had undergone antecubital attempt at insertion of the SNF, Seventy-four consecutive patients were enrolled during a 29-month peri od. A PICC was inserted concomitantly in 23 of these patients. The ser ies included 38 men and 36 women, with a mean age of 62.5 years (range , 17-88 years), The clinical indications for filter placement included contraindication to anticoagulation (81.1%), complication of anticoag ulation (9.4%), failure of anticoagulation (8.1%), and prophylactic pl acement (1.4%). Concomitant PICCs were inserted for chemotherapy (56.5 %), venous access (39.1%), and total parenteral nutrition (4.4%). Clin ical follow-up was available in 61 patients. Mean follow-up was 124 da ys (range, 0-884 days). RESULTS: The SNF was successfully placed via t he antecubital vein in 98.6% of the patients. In one patient, access w as via the right common femoral vein because of failed right arm acces s. There was a question of pulmonary embolism (PE) after filter placem ent in two patients. Otherwise, there were no complications related to placement of either the filter or PICC, CONCLUSION: Antecubital venou s insertion of the SNF is a safe and effective method for the preventi on of PE in patients who cannot be managed with traditional anticoagul ation, and offers the option of inserting a PICC with no added complic ations.