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Correlation of IVUS and CT Scan Measurements for Placement of IVUS-Guided IVC Filters
Sean J. Hislop, MD, Dustin J. Fanciullo, MD, Adam J. Doyle, MD, Michael J. Singh, MD, Jason K. Kim, MD, Ankur Chandra, MD, Nicole A. Stassen, MD, David L. Gillespie, MD.
University of Rochester, Rochester, NY, USA.
OBJECTIVES: The use of intravascular ultrasound to place bedside IVC filters has the potential to increase patient safety due to decreased need for patient transport and its use in patients with open abdomen. IVUS has been criticized for an increased rate of malpositioned IVC filters. The purpose of this study was to evaluate the utility of correlating preprocedure CT scan measurements with IVUS derived measurements of anatomic structures for assistance in placement of bedside IVUS-guided inferior vena cava (IVC) filters.
METHODS: A retrospective review of prospectively collected data was performed on all patients receiving bedside IVUS guided filters from July 1, 2010 and August 31, 2011. Measurements of the inferior vena cava length from the atrial-IVC junction to the mid-portion of the crossing right renal artery, the lowest renal vein and iliac vein confluence were obtained prior to IVC filter placement by evaluation of existing CT scan data and intra-operatively by IVUS pullback. Regression analysis (significant for P < 0.05) was used to determine if there was a correlation between measurements obtained by IVUS as compared to those obtained using preprocedure CT imaging.
RESULTS: Over this 13 month period of time there were 27 bedside IVUS filters placed. There were 22 patients who had both IVUS and CT scans available to perform the analysis. All IVUS guided filters were placed using the single puncture technique using the Cook Celect Filter system. There was a correlation between IVUS and CT derived measurements of the right atrium - right renal artery distance (P < 0.001), right atrium - lowest renal vein distance (P < 0.001) and right atrium - iliac confluence distance (P < 0.001). There were no complications or malpositions of IVC filters using this protocol.
CONCLUSIONS: These data suggest that IVUS pullback measurements from the right atrium in combination with preprocedure CT derived measurements of the distance from the right atrium to the lowest renal vein and right atrium to the iliac vein confluence provide an accurate roadmap for the placement of bedside IVC filters under IVUS guidance. We suggest this easily employed technique be more fully utilized to help decrease the incidence of malplaced filters using IVUS guidance alone.
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