In this prospective blinded study of inferior vena caval (IVC) patency, 18 patients underwent 25 duplex ultrasound (US) and magnetic resonance (MR) angiography examinations over an eight-month period following Simon nitinol filter placement. Clinical examination for lower extremity venous stasis and plain abdominal radiography were also performed. Twenty-three of 24 MR ex aminations and 11 of 24 US examinations were judged technically adequate by the blinded observers. One technically adequate US exam was false positive for intraluminal caval thrombus. Thirteen technically inadequate US examinations missed 3 complete caval occlusions and 2 partial occlusions. MR identified all patients with complete or partial caval occlusion.
The authors conclude that duplex US reliably confirms IVC patency only when strict criteria for technical adequacy and interpretation are met (good visualization of filter and IVC above and below filter). MR, although expensive, more reliably identifies nonoccluding intraluminal thrombus and caval occlu sion. It should be the noninvasive study of choice in symptomatic patients with venous stasis and patients with recurrent pulmonary emboli.
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References
1.
Simon M., Athanasoulis CA, Kim, D., et al: Simon nitinol inferior vena cava filter: Initial clinical experience . Radiology172:99-103, 1989.
Greenfield LJ , Peyton R., Crute S., et al: Greenfield vena caval filter experience: Late results in 156 patients. Arch Surg116:1451-1456, 1981.
4.
Kim D., Porter DH, Siegel JB, et al: Perforation of the inferior vena cava with aortic and vertebral penetration by a suprarenal Greenfield filter. Radiology172:721-723, 1989.
5.
Bounameaux H. , Velebit V., Battikha J., et al: Recurrent, fatal pulmonary embolism despite inferior vena cava interruption with the Greenfield filter. Vasa16:84-85, 1987.
6.
Carabassi RA III, Moritz MJ, Jarrell BE: Complications encountered with the use of the Greenfield filter. Am J Surg154:163-168, 1987.
7.
Kantor A., Glanz S., Gordon DH, et al: Percutaneous insertion of the Kimray-Greenfield filter. AJR149: 1065-1066, 1987.
8.
Castaneda F. , Herrera M., Cragg AJ, et al: Migration of a Kimray-Greenfield filter to the right ventricle. Radiology149:690, 1983.
McCowan TC, Ferris EJ, Carver DK, et al: Amplatz vena caval filter: Clinical experience in 30 patients . AJR155:177-181, 1990.
12.
Fobbe F., Dietzel M., Korth R., et al: Gunther vena caval filter: Results of long-term follow-up. AJR151:1031-1034, 1988.
13.
Greenfield LJ: Current indications for and results of Greenfield filter placement. J Vasc Surg1:377-382, 1984.
14.
Fobbe F., Dietzel M., Korth R., et al: Gunther vena caval filter: Results of long term follow-up. AJR151:1031-1034, 1988.
15.
Roehmm JOJr , Johnsrude IS, Barth HM, et al: The Bird's nest inferior vena cava filter: Progress report. Radiology118:745-749, 1988.
16.
Epstein DH, Darcy MD, Hunter DW, et al: Experience with the Amplatz retrieval vena cava filter. Radiology172:105-110, 1989.
17.
Pasto ME, Kurtz AB, Jarrell BE, et al: The Kimray-Greenfield filter: Evaluation by duplex real time/ pulsed Doppler ultrasound. Radiology148:223-226, 1983.
Edelman RR, Wenz K., Mattel HP, et al: Projection arteriography and venography of the head and body: Initial clinical application using magnetic resonance. Radiology172:351-357, 1989.
20.
Edelman RR, Zhao B., Liu C., et al: MR angiography and dynamic flow evaluation of the portal venous system. AJR153:755-760, 1989.
21.
Spritzer CE , Sostman HD, Wilkes DC, et al: Deep venous thrombosis: Experience with gradient-echo MR imaging in 66 patients. Radiology177:235-241, 1990.
22.
Erdman W., Weinreb J., Cohen J., et al: Venous thrombosis: Clinical and experimental MR imaging. Radiology161:233-238, 1986.
23.
Edelman RR, Mattel H., Kleefield J., et al: Dynamic MRI and quantification of flow using presaturation bolus tracking. Radiology171:551-556, 1989.
