Clinical Value Of Inferior Vena Caval Filter Insertion Under CDFI Guidance Through Right Internal Jugular Vein

Objective To explore the feasibility and safety and clinical value of color Doppler flow imaging guided inferior vena caval filter insertion(IVCFI) to prevent pulmonary embolism through right internal jugular vein during treatment of deep venous thrombosis (DVT) in the lower extremity, as a basis for clinical treatment.Methods Between June 2005 and January 2011, under guidance of CDFI, to prevent pulmonary embolism or postfilter pulmonary embolism 38 patients with lower extremity deep venous thrombosis, which was confirmed by clinical and CDFI,were selected for inferior vena caval filter insertion (IVCFI) through right internal jugular vein. No patients had a contraindication to anticoagulation. All patients were treated with anticoagulation and thrombolysis after inferior vena caval filter insertion(IVCFI). Whether patients occurred pulmonary embolism was observed clinically, and the form and site of inferior vena caval filters were monitored by color Doppler flow imaging regularly. After 32 to 45 days'placement, retrievable filters were retrieved under CDFI guidance via right internal jugular vein. All patients were followed up to monitor filter complications and PE and recurrent PE.Result Screening of CDFI was performed in 38 patients before insertion of filters. Locations of right internal jugular vein, inferior vena caval, bifurcation of common iliac vein, and bilateral renal vein were documented. All the veins were regular. The diameter of the inferior vena cava ranged from 17mm to 27mm. The average diameter of IVC was 22mm. All IVC without thrombosis could be visible and suitable for the requirement of filter. Under the guidance of CDFI,23 retrievable IVC filters and 15 permanent IVC filters were placed without technical difficulty via right internal jugular vein. Follow-up examination of CDFI and X-ray abdominal plain film showed all the filters were placed in right position and opened up completely.23 retrievable filters were retrieved via right internal jugular vein. The placement time of retrievable filters was 32～45 days,with an average period of 38.5 days. Fourteen cases(36.5%) with embolus trapped by IVC filter were found. All patients had no filter migration,filter tilting,filter fracture,IVC perforation,PE,or recurrent PE. Thrombus attached to retrievable filter after the retrievable filter taking off from IVC was found in 2 cases despite inferior vena-cavography were negative. One patient with permanent filter presented inferior vena caval occlusion at 13 months.Conclusion Insertion of the inferior vena cava filter is safe and feasible under CDFI guidance via jugular vein approach. Compared with X-ray guidance, CDFI-directed IVCFI also is simple, feasible and substantially reduces the procedural cost and avoids the threat of radiation exposure.