Placement of vena cava filters: Factors affecting technical success and immediate complications

OBJECTIVE. The goal of this study was to evaluate factors affecting technical success and the immediate complications of placement of vena cava filters. MATERIALS AND METHODS. The medical records of 148 consecutive patients who underwent filter placement between December 1995 and February 1999 were retrospectively reviewed for cavography, technical success, complications, and operator specialty. RESULTS. The records of 143 filter placements in 142 patients were complete (one patient underwent two placements). One hundred twenty filter placements were preceded by cavography, and 23 were not. Three misplacements (2.5%) were preceded by cavography and 10 (43%) were not (p < 0.0001). One hundred fourteen filter placements were performed by radiologists and 29 by surgeons. Cavography was performed before 98% of placements by radiologists but in only 28% of placements by surgeons (p < 0.0001). Filter misplacement occurred in 12 placements (41%) by surgeons and in only one (0.9%) by radiologists (p < 0.0001). Major complications occurred in three placements (10%) by surgeons and in none of the placements by radiologists (p < 0.01). CONCLUSION. Vena cava filters were placed with greater technical success and fewer complications when preceded by cavography. Radiologists placed filters with greater technical success and fewer complications than surgeons, which may be the result of radiologists generally having more training and more familiarity with imaging-guided procedures and adhering more to cavography protocol. A credentialing requirement for physician operators and evaluation using quality improvement standards may be advisable.