Filter placement in the IVC is an established procedure to prevent PE from DVT of lower extremities and pelvis. The incidence of PE from DVT of the upper extremities is increasing in this era of aggressive medical therapy and widespread use of central catheters. Some patients with IVC occlusion may develop large collaterals draining into the azygos veins. Therefore, in some of these patients the placement of a filter in the SVC and/or azygos is necessary to prevent PE from the SVC and upper extremities DVT. We understand that this topic is controversial and has not received adequate attention in the literature. We, therefore, present our experience with 20 patients.
We have placed filters in these very unusual locations in 20 patients. Filters were placed in the SVC in 17 patients and in the azygos vein in 3 patients. Some of these patients also required placement of filters in the IVC. Filters used were the “old” stainless steel Greenfield, the Titanium Greenfield, the “new” stainless steel Greenfield, the Simon Nitinol, the Gu" nther tulip, and the Trap ease filters.
All procedures were successful. No complications related to the procedures were recorded. No SVC or azygos occlusions were found. No migration or misplacement occurred.
Placement of filters in the SVC and/or azygos system is a safe, easy, effective, albeit controversial, method to prevent PE in certain patients under specific circumstances.
Some patients with SVC and/or upper extremity DVT can benefit from placement of a filter in the SVC and/or azygos vein. It is safe to insert a filter in the SVC.
Jaime Tisnado, None.