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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