Paul Anthony Vesco, MD Mark Falimirski MD, Kenneth Williams MD, and Joseph Young MD General Surgery Allegheny General Hospital, Pittsburgh PA

Purpose: This study will examine the reliability of incidental spiral computed abdominal tomography (CAT) (with venographic images) for the placement of inferior vena cava (TVC) filters. The CAT scan will assess the 1) size of the 1VC, 2) location of the renal vessels, and 3) identification of significant venous anomalies in place of a contrast venagram.

Methods: Over a 13-month period, data was prospectively collected on patients at high risk for pulmonary embolism (PE) or with PE that required an IVC filter. Incidental CAT scans were performed prior to the need for filter placement. CAT data was extrapolated to vertebral levels for the placement of the IVC filter under fluoroscopy.

Results: 72 patients had IVC filters placed with the use of a prior abdominal spiral CAT scan to assess the IYC. In the last 33 patients, CAT scan placement has been verified with post deployment venagram. 90% of filters were placed within 5 mm of the lowest renal vein with an average of 3.5 mm. 1VC size by cavography was +1-1.9 mm of the IVC width by CAT. 7 of 72 (9.7%) had some aspect of placement affected by CT scan cavography.

Conclusions: Admission or same hospital stay spiral CAT scan can provide enough anatomic detail to safely guide placement of an IVC filter. Filters can be done at bedside without venagrams if the preplacement CAT is adequate.



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