Impact of Access Site Choice on Inferior Vena Cava Filter Angulation and Outcomes.

INTRODUCTION: In this study we aim to compare the outcomes of inferior vena cava (IVC) filter placement between femoral and internal jugular vein access sites.

METHODS: This is a retrospective study utilizing the Vascular Quality Initiative (VQI) database assessing patients who underwent IVC filters placed between 2013 - 2019. Patients were placed into two groups based on access site location: the femoral vein (FV) or internal jugular (IJ) vein. The femoral group included patients accessed via the right and left femoral veins and other leg veins, while the internal jugular group patients were accessed via the right or left jugular vein. Primary outcome was rate of filter angulation. Secondary outcomes included access site complications such as DVT, hematoma and bleeding requiring transfusion.

RESULTS: There were 13,221 patients who underwent IVC filter placement with 8,214 (63%) patients via transfemoral access and 4,789 (37%) patients via trans-jugular access with 218 unknown or excluded. Within the IJ group, 98.0% (n= 4,696) were accessed via right IJ and 2% (n=93) were via the left IJ. Within the femoral group (common femoral, femoral or other infrainguinal veins), 85.3% (n=7,007) were accessed on the right and 14.6% (n= 1,207) were accessed on the left. The mean age of the patients was 63 ± 15.9, mean BMI was 30.9 ± 9.60 and 52.0% (6,788) of the patients were men. The most common indication for filter placement was contraindication to anticoagulation due to a recent/active bleed (30%), followed by planned surgery (22%), new DVT/PE (7%), fall risk (5%), and trauma (4%). Infrarenal filters were placed in 97.9% of patients. Univariate analysis identified BMI and suprarenal placement as independent risk factors for angulation. Final multivariate analysis showed there was a significant increase in angulation in the femoral access group (0.9% vs 0.34%; OR 1.46 CI 1.02-2.11; p=0.04) as well as increased access site complications in the femoral access group (0.25% vs 0.07%; OR 2.068; CI 1.01-4.23; p=.048). No significant correlation between access site choice and retrieval rate was found (p=0.9270).

CONCLUSIONS: Placement of IVC filters via transjugular access has a lower rate of filter angulation in the IVC and fewer access site complications compared to femoral access.