Vena Cava Filter Placement Using a Cutdown of the Superficial Epigastric Vein

Abstract

Percutaneous placement of vena cava filters through the femoral vein has been associated with insertion site venous thrombosis. Reported incidence varies from 2% to 41%. In the majority of placements, sequential dilators are used to create the venotomy and subcutaneous tract. This technique disrupts all layers of the vein wall. The injured area may extend as far proximal as the dilator or sheath is placed. The authors present their experience with placement of vena cava filters using a cutdown of the superficial epigastric vein. During a 5-year period, 27 patients underwent placement of the LGM-Vena Tech vena cava filter via a femoral approach. A cutdown of the superficial epigastric vein was performed. The guidewire, dilator, and introducer sheath were inserted under direct fluoroscopic examination. After removal of the dilator, the LGM-Vena Tech filter was placed through the introducer. There were no wound infections and no clinical signs of insertion site venous thrombosis in the postoperative period. Insertion site venous thrombosis is a well-documented complication of percutaneous filter placement. Superficial epigastric vein cutdown is a reasonable alternative technique, which allows gentle atraumatic manipulation of the femoral vein. It is a simple, safe procedure that can be performed without any significant increase in operative time and no additional morbidity.