Duplex Directed Caval Filter Insertion in Multi-Trauma and Critically Ill Patients

Advances in Surgical Critical Care

“…Ultrasonographic. 30 The exact same maneuvers are performed, but guidance is achieved by ultrasound. Because most ICU surgical patients have abdominal operations with distorted anatomy or distended bowel, which compromises ultrasonographic imaging, we believe that this technique is not ideal in the ICU.…”

Venous Thromboembolism in Trauma

“…A few authors have described bedside filter placement in those patients targeted as too critically ill to be transported for conventional placement. [127][128][129][130][131][132] A large number of these patients evaluated for ultrasound-guided bedside filter placement fail initial sonographic evaluation because of extensive bowel gas, obese body habitus, or overlying abdominal dressings and drains. Many of these patients eventually have their filters placed using conventional fluoroscopic guidance.…”

Vena Cava Filters

“…Recently, several authors have advocated bedside filter placement as a safe and cost-effective method. [56][57][58] The perceived advantages include the avoidance of radi- ation exposure and administration of iodinated contrast media if ultrasonography is used, elimination of the need for patient transport to the angiography suite, and potential cost savings. If fluoroscopic guidance is used, the patients may have to be moved to a fluoroscopecompatible bed.…”

“…With duplex sonography, the suggested approach is to localize the right renal artery or the left renal vein and use this level as the reference marker for filter placement. 57 This approach may not allow for the identification of a significant number of anatomic variants that may influence caval filter placement. A comparative study regarding the sensitivity and specificity of duplex sonography and cavography in detecting venous variants has not been performed.…”