Over-the-Wire Technique for IVC Filter Placement

[Michael Barraza]
I was hoping you could just start by telling me a little bit about your IVC filter placement and retrieval programs at Columbia.

[David Mobley]
It's pretty standard and it follows the recommendations by the Society of Interventional Radiology guidelines. It's put in when indicated and there are several indications for placement and obviously filter. We try to remove them as soon as possible when it's indicated and when the patients are able to have them removed.

[Michael Barraza]
Okay, and so I've read a poster you guys did on a placing the Option filter over the wire. Could you tell me a little bit about that?

[David Mobley]
Sure. For years we've been placing filters in the IVC and we've been placing them jugularly and femorally like the rest of the country. The Argon Rep had come to me and said, ”Listen, we've got this filter which we had been using for awhile." And he said, "This filter is the only one that has a hole right through the middle.” He had this idea of placing it over the wire with the wire extended all the way into: either the femoral up into the SVC, or jugularly down into the Iliac vein, and deploying it with that wire extended all the way distally.

There has been some contention with the placing and tilting of filters within the IVC. It's believed that tilting of the filter makes it less effective in its protection from DVTs and creating pulmonary embolisms. Also, it's believed that the increased tilting makes it more difficult to remove depending on how long it's been in. We had placed many of our filters through jugular and transfemoral access points. When Mike came to me and made this suggestion, I listened to him and talked to him about the technique.

I tried it a few times and it worked out very nicely and I said, “alright, well let's take a look at this.” So we did. I believe it was around 39 patients and we looked retrospectively at those patients, and the 40 patients prior to that, that had been performed with transfemoral access. We looked to see if there was a difference in tilting and it showed a statistically significant difference in tilting between the filters placed over the wire and not over the wire.

[Michael Barraza]
I have used a lot of these filters and I haven't done them with a wire. Would you mind walking me through, start to finish, how you would place this over the wire?