Engmann E, Asch M R
Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
J Vasc Interv Radiol. 1998 Sep-Oct;9(5):774-8. doi: 10.1016/s1051-0443(98)70390-2.
To evaluate the Simon nitinol vena cava filter (SNF) placed via the antecubital vein in a series of patients. Issues examined by the authors included insertion site variables, filter efficacy, and complications. The authors also explored the option of placement of a peripherally inserted central catheter (PICC) via the same access site.
This was a prospective study that included all patients who had undergone antecubital attempt at insertion of the SNF. Seventy-four consecutive patients were enrolled during a 29-month period. A PICC was inserted concomitantly in 23 of these patients. The series included 38 men and 36 women, with a mean age of 62.5 years (range, 17-88 years). The clinical indications for filter placement included contraindication to anticoagulation (81.1%), complication of anticoagulation (9.4%), failure of anticoagulation (8.1%), and prophylactic placement (1.4%). Concomitant PICCs were inserted for chemotherapy (56.5%), venous access (39.1%), and total parenteral nutrition (4.4%). Clinical follow-up was available in 61 patients. Mean follow-up was 124 days (range, 0-884 days).
The SNF was successfully placed via the antecubital vein in 98.6% of the patients. In one patient, access was via the right common femoral vein because of failed right arm access. There was a question of pulmonary embolism (PE) after filter placement in two patients. Otherwise, there were no complications related to placement of either the filter or PICC.
Antecubital venous insertion of the SNF is a safe and effective method for the prevention of PE in patients who cannot be managed with traditional anticoagulation, and offers the option of inserting a PICC with no added complications.
