The next frontier of office-based inferior vena cava filter placement

Objective: There is an increasing number of procedures that traditionally were performed in the inpatient setting that are now becoming office-based procedures. These include peripheral endovascular procedures such as angiograms, angioplasties, dialysis access interventions, and treatment for venous insufficiency. We chose to evaluate the feasibility, safety of inferior vena cava (IVC) filter placement in the office-based setting. Methods: All procedures were performed using local anesthesia, and ultrasound guidance for puncture. All venograms were performed with manual injection of iodinated contrast. An IVC filter was placed in the cases (except one failure of placement) using fluoroscopy in the infrarenal position. Patients were observed in a recovery area and then discharged. Follow-up data were obtained through an interview, physical examination, and 24-hour postoperative phone call. Results: Over the course of 27 months, 29 Greenfield filters (Boston Scientific, Marlborough, Mass) and three Celect temporary filters (Cook, Bloomington, Ind) were placed in the infrarenal IVC for 18 women and 14 men, with an average age of 75.3 +/- 15.6 years (range, 38-97 years). Twenty-four acute, 6 recent (<6 months ago) and three subacute lower extremity deep vein thromboses (DVTs) were identified. The indications for the procedure were patients with: DVT who were to undergo surgery (n = 6), acute large free-floating iliofemoral DVT (deemed high-risk for long-term anticoagulation) (n = 7), new DVT during anticoagulation therapy (n = 6), DVT with gastrointestinal bleeding (n = 4), DVT with hematuria (n = 2), recent DVT (which extended during full dose anticoagulation treatment) while undergoing a long flight (n = 1) (temporary filter placement), DVT with arm hematoma (n = 1), DVT with unsteady gait and history of falls (n = 2), DVT with nose bleeding (n = 1), DVT with dementia and inability to receive anticoagulation treatment (n = 1), DVT and receiving chemotherapy and with thrombocytopenia (n = 1), and DVT and refusal to take anticoagulation medication (n = 1). One patient had a failure to place a filter because of chronic IVC occlusion found on venogram. One patient with history of gastrointestinal bleeding, acute DVT, and atrial fibrillation suffered IVC filter thrombosis 1 month after the procedure. We attempted removal of the temporary filters in the hospital in two patients but failed to retrieve the filter in these two cases. We noted no insertion site DVT, extension of DVT, or pulmonary embolism. Conclusions: Our preliminary experience suggests that placement of IVC filters for treatment of venous thrombotic events in an office-based facility is safe and efficacious with basic endovascular equipment. Long-term outcome cannot be determined at this point.