Abstract:
PURPOSE:To compare the accuracy of inferior vena cava (IVC) filter placement using a bedside technique guided by intravascular ultrasound (IVUS) with a concurrent experience of filter deployment with fluoroscopic venogram imaging. METHODS:From November 2006 to December 2009, 195 consecutive IVC filters were placed to prevent pulmonary embolism in 120 high-risk patients without lower limb deep vein thrombosis (DVT) and 75 patients with DVT and anticoagulation contraindications. Filter insertion techniques included bedside IVUS-guided (n = 97) and fluoroscopic-guided (n = 98) procedures. Before mid-2008, 2 bedside IVUS-guided protocols were used evolving from a single-puncture, pullback technique (n = 48), in which the measured distance from the venous access site to the IVC landing zone then allowed a calibrated reinsertion of a 7F delivery sheath and filter deployment. After mid-2008, a single puncture 8F sheath technique (n = 48) using IVUS to position the delivery sheath tip within the IVC landing zone without catheter or sheath measurement or reinsertion was used. Venous access was via the right femoral (84 IVUS and 56 fluoroscopy), left femoral (10 IVUS and 16 fluoroscopy), or right internal jugular vein (3 IVUS and 26 fluoroscopy). The 3 filter insertion techniques were compared for "optimal" IVC placement defined as the filter positioning between L1 and L4 vertebrae with tilt <15° based on postprocedure abdominal x-rays or venography. RESULTS:Filter malposition occurred with 6% (6 of 97) bedside IVUS-guided procedures with no malpositions during fluoroscopic imaging. Malposition was lower with the evolved sheath (4%, 2 of 48) compared with the earlier pullback (8%, 4 of 48) insertion technique (P = .03). The incidence of the filter malposition during IVUS-guided deployment was highest using left femoral access (4 of 10) compared with right femoral (2 of 84) or internal jugular (0 of 3) vein access (P < .01). Filter tilt occurred more after IVUS-guided procedure (10 of 97) than fluoroscopic procedure (3 of 98; P = .05) and was most frequent for left femoral access (5 of 10 IVUS and 1 of 16 fluoroscopy; P < .01) and was not related to filter type (P = .13). CONCLUSION:Our current bedside IVUS-guided IVC filter technique using a single venous puncture and single sheath positioning has improved the placement accuracy. Left femoral venous access should be avoided to minimize the occurrence of filter malpositioning and tilt.
journal_name
Vasc Endovascular Surgjournal_title
Vascular and endovascular surgeryauthors
Hodgkiss-Harlow K,Back MR,Brumberg R,Armstrong P,Shames M,Johnson B,Bandyk DFdoi
10.1177/1538574411434495subject
Has Abstractpub_date
2012-05-01 00:00:00pages
293-9issue
4eissn
1538-5744issn
1938-9116pii
1538574411434495journal_volume
46pub_type
杂志文章abstract::Patients with chronic occlusion of iliac veins may present with symptoms ranging from mild discomfort to severe disability, including limb swelling, venous claudication, and ulceration. Endovascular treatment has emerged as first line of interventional therapy. Surgical venous-venous bypasses for the management of the...
journal_title:Vascular and endovascular surgery
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abstract:OBJECTIVES::To evaluate the effects on aortoiliac fluid dynamics after the implantation of an endograft based on endovascular aneurysm sealing (EVAS) versus endovascular aneurysm repair (EVAR) strategy. METHODS::An adaptive geometrical deformable model was used for aortic lumen segmentation in 8 patients before and af...
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journal_title:Vascular and endovascular surgery
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abstract::Arteritis and mycotic aneurysms have been well described for more than 100 years. The authors report a case of bacterial arteritis that presented with pneumatosis of the aortic wall and that evolved over 1 week into an infected abdominal aortic aneurysm. This case documents the rapid progression from arteritis to myco...
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abstract:INTRODUCTION:Despite advances of endovascular interventions, bypass surgery remains the gold standard for treatment of long and complex arterial occlusions in the lower limb. Autologous vein is regarded superior to other options. As the graft of first choice, the great saphenous vein (GSV) is often not available due to...
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pub_type: 杂志文章,多中心研究
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abstract:INTRODUCTION:Inflammatory bowel disease (IBD) is a chronic multisystem inflammatory condition with associated endothelial dysfunction and dysregulated coagulation. Although deep venous thrombosis (DVT) in IBD has been well described, arterial thrombosis and thromboembolism are less commonly appreciated. METHODS:A 63-y...
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更新日期:2020-10-01 00:00:00