Abstract
Purpose
To evaluate routine use of access sites in the arm for percutaneous caval filter placement (PCFP) in elderly patients. Neck arthritis, patient anxiety, access site thrombosis or fecal/urinary incontinence complicating jugular or femoral access may require alternative access sites in this population.
Methods
Access via the right arm was chosen for PCFP (VenaTech LP). The indication for PCFP was deep vein thrombosis, a history of pulmonary embolism, and a contraindication to anticoagulant therapy. Ultrasound-guided puncture was performed after diameter measurement of the arm veins (ØAV). The filter was inserted with standard imaging procedures. Procedural difficulty was graded and compared with ØAV and the angle from the arm vein to the superior vena cava (αAV/SVC).
Results
Over 2 years, 16 patients (14 women, 2 men) with an average age of 90 years (range 79–97 years) were included in the study. The average ØAV value of the basilic or brachial veins was 4.2 mm (range 3.0–5.1 mm). The minimal ØAV for successful access was determined after the first 15 patients. No hematoma occurred at the puncture sites. The average αAV/SVC value was 62° (range 29°–90°). Arm access was possible in 12 of 16 patients (75%) with ØAV ≥ 3.5 mm and αAV/SVC ≥ 29°. Every procedure via the arm was graded “easy” by the operator, regardless of angulation values. Femoral access was used in one case due to the impossibility of traversing the heart (patient no. 2), and jugular access was used in 3 of 16 (19%) patients due to puncture failure (patient no. 4), small ØAV (3 mm) (patient no. 6), and stenosis of the distal right subclavian vein (patient no.16), respectively.
Conclusion
PCFP via the arm can be routinely accomplished in patients older than 75 years, provided ØAV ≥ 3.5 mm, and αAV/SVC ≥ 29°.
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Acknowledgments
The authors thank Sandrine Boucheteil and Cécile Huber for clinical data collection and literature research; Rémy Bourel, Thierry Riou, Frantz Fremcourt, and Michel Touzet, PhD, for imaging postprocessing; Alain Goasdoué, Jacqueline Saindrenan, Dominique Borval, David Mouchot, Teofila Paulo, and Daniel Bouffechoux for patient management; Martine Conseil, Liliane Lavoillotte, Netty Boucaud, Frank Espagnet, and Catherine Tricot for technical assistance; and Claude Desmolins for radiation protection.
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Blanche, A.F.L., Pautas, E., Gouin, I. et al. Placement of the VenaTech LP Caval Filter in the Elderly: Feasibility and Clinical Benefits of Insertion Via the Arm. Cardiovasc Intervent Radiol 28, 813–817 (2005). https://doi.org/10.1007/s00270-004-0119-0
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DOI: https://doi.org/10.1007/s00270-004-0119-0