Clinical experience with the antecubital Simon nitinol IVC filter.

PURPOSE: To evaluate the Simon nitinol vena cava filter (SNF) placed via the antecubital vein in a series of patients. Issues examined by the authors included insertion site variables, filter efficacy, and complications. The authors also explored the option of placement of a peripherally inserted central catheter (PICC) via the same access site.

MATERIALS AND METHODS: This was a prospective study that included all patients who had undergone antecubital attempt at insertion of the SNF. Seventy-four consecutive patients were enrolled during a 29-month period. A PICC was inserted concomitantly in 23 of these patients. The series included 38 men and 36 women, with a mean age of 62.5 years (range, 17-88 years). The clinical indications for filter placement included contraindication to anticoagulation (81.1%), complication of anticoagulation (9.4%), failure of anticoagulation (8.1%), and prophylactic placement (1.4%). Concomitant PICCs were inserted for chemotherapy (56.5%), venous access (39.1%), and total parenteral nutrition (4.4%). Clinical follow-up was available in 61 patients. Mean follow-up was 124 days (range, 0-884 days).

RESULTS: The SNF was successfully placed via the antecubital vein in 98.6% of the patients. In one patient, access was via the right common femoral vein because of failed right arm access. There was a question of pulmonary embolism (PE) after filter placement in two patients. Otherwise, there were no complications related to placement of either the filter or PICC.

CONCLUSION: Antecubital venous insertion of the SNF is a safe and effective method for the prevention of PE in patients who cannot be managed with traditional anticoagulation, and offers the option of inserting a PICC with no added complications.