Duplex ultrasound insertion of inferior vena cava filters in multitrauma patients

BACKGROUND: Techniques for placement of inferior vena cava (IVC) filters ha ve undergone continued evolution from open surgical exposure of the venous insertion site to percutaneous insertion in most cases today. However, the required transport either to an operating room or interventional suite call be complex and potentially hazardous for the multiply injured trauma patie nt who may require ventilator support, controlled intravenous infusions, or skeletal immobilization, Increased experience with color-flow duplex scann ing for routine IVC imaging and portability of ultrasound equipment have su ggested the usefulness of duplex-guided IVC filter insertion (DGFI) in crit ically ill trauma and intensive care unit (ICU) patients. METHODS: A total of 25 multitrauma/ICU patients were considered for DGIF. S creening color-flow duplex scans were performed on all patients, and obesit y or bowel gas prevented ultrasound imaging in 2 cases, leaving 23 patients suitable for DGFI. In each case, the IVC was imaged in the transverse and longitudinal planes. The right renal artery was identified as it passed pos terior to the IVC and was used as a landmark of the infrarenal segment of t he IVC. All procedures were performed at the bedside in a monitored ICU set ting using percutaneous placement of titanium Greenfield filters. Duplex sc anning after insertion was used to document proper placement, and circumfer ential engagement of the filter struts in the IVC wall. An abdominal radiog raph was also obtained in each case to confirm proper filter location. Dupl ex ultrasound imaging was repeated within 1 week of insertion to assess IVC and insertion site patency, RESULTS: DGFI was successful in all cases. The filter was deployed at a sup rarenal lever in one case, as was recognized at the time of postprocedural scanning. Three patients died as a result of their injuries but there were no pulmonary embolism deaths. Repeat duplex scanning was obtained in 17 pat ients, and revealed no case of IVC or insertion site thrombosis. CONCLUSIONS: Vena caval interruption can be safely performed under ultrasou nd guidance in a monitored, ICU environment. In selected multiply injured t rauma patients, this will reduce the risk, complexity and cost of transport for these critically ii patients. DGFI also reduces procedural costs compa red with an operating room or interventional suite, and eliminates intraven ous contrast exposure. Preprocedural scanning is essential to identify pati ents suitable for DGFI, and careful attention must be paid to the known ult rasonographic anatomical landmarks, Am J Surg. 1999;178:92-97. (C) 1999 by Excerpta Medica, Inc.