Impact Of Access Site Choice On Outcomes Of Inferior Vena Cava Filter Placement

Limited studies have evaluated optimal access site choice during placement of inferior vena cava (IVC) filters. In this study, we aim to compare the outcomes of IVC filter placement between femoral and internal jugular vein access sites. This is a retrospective study using the Vascular Quality Initiative database in which we identified 13,003 patients who underwent IVC filters placed between 2013 and 2019. We separated the patients into two groups based on access site: femoral vein vs internal jugular veins. The femoral group included patients accessed via the right and left femoral vein and other leg veins, whereas the internal jugular group patients were accessed via the right or left jugular vein. We analyzed outcomes including rates of angulation greater than 20°, as well as access site complications that included deep vein thrombosis, hematoma, and bleeding requiring transfusion. In total, 13,003 patients underwent IVC filter placement with 8214 (63%) patients via femoral access and 4789 (37%) patients via jugular access. The mean age of the patients was 63 ± 15.99, the mean body mass index was 30.88 ± 9.60, and 52% (6788) of the patients were male. The most common indication for filter placement was contraindication to anticoagulation due to a recent or active bleed (30%), followed by planned surgery (22%), new deep vein thrombosis/PE (7%), fall risk (5%), and trauma (4%). Infrarenal filters were placed in 97.9% of patients. Univariate analysis identified body mass index and suprarenal placement as an independent risk factor for angulation. Final multivariate analysis (Table) showed that there was a significant increase in angulation for the femoral access group (0.9% vs 0.34%; odds ratio: 1.46, confidence interval: 1.015-2.114; P = .0414) as well as increased access site complication in the femoral access group (0.25% vs 0.07%; odds ratio: 2.068, confidence interval: 1.005-4.225; P = .0483). Placement of the IVC filter via jugular access has a lower rate of angulation and lower rate of access site complication compared with femoral access.TableFrequency of inferior vena cava (IVC) filter angulation and insert site complications according to insert siteInsert siteInternal jugularFemoralTotalP valueAngulation40 (0.34)105 (0.9)145 (1.24).0414Complication9 (0.07)33 (0.25)42 (0.32).0483Values are frequency number (%). A total of 1328 patients had missing angulation data, 9 patients had missing insert site complication data. Jugular access site includes right and left internal jugular veins, and femoral insert site includes right and left femoral and other leg veins. Open table in a new tab