WASHINGTON, DC - Vena cava filters inserted by vascular surgeons are far more likely to be misplaced than those inserted by interventional radiologists, according to research presented May 10 at the centennial meeting of the American Roentgen Ray Society.
To evaluate the technical success and immediate complications of vena cava filter placements, researchers at the St. Joseph Mercy Hospital in Pontiac, MI, retrospectively reviewed medical records and radiographs of 148 consecutive patients who underwent the procedure at their facility between December 1995 and February 1999.
The records of 142 patients were complete. Among these patients, interventional radiologists (IR) had placed 114 filters, while vascular surgeons (VS) placed 28. Patient demographics were similar for both groups.
Inferior vena cavagrams were obtained prior to all IR placements, but in only 25% of VS placements. Filter misplacements occurred in 12 (43%) of the VS placements, but in only 1 (0.9%) of the IR placements. The misplacement rate among VS was higher than reported in previously published studies, while the IR misplacement rate was similar, according to Dr. Harish Panicker of St. Joseph Mercy.
None of the VS misplacements were recognized at the time of insertion. Of these misplacements, three (11%) were inserted in iliac veins, and nine (32%) were placed above the renal veins.
Major complications occurred in two (7%) of the VS placements and in none of the IR placements. Both complications involved patients with filter misplacement in iliac veins, specifically retroperitoneal hematoma requiring transfusion and pulmonary embolus likely from existing unprotected deep vein thrombosis in the contralateral extremity.
Panicker said the superior performance of interventional radiologists over vascular surgeons could be attributed to the former group's training in image-guided procedures, and adherence to procedure-related imaging protocols.
"Surgeons do not usually receive that same training," he said.
To guard against poorly placed vena cava filters, hospitals should set up appropriate credentialing and quality improvement programs for those who perform the procedures, he said.
By Erik L. Ridley
AuntMinnie.com staff writer
May 11, 2000
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
