Placement of the VenaTech LP Caval Filter in the Elderly: Feasibility and Clinical Benefits of Insertion Via the Arm

To evaluate routine use of access sites in the arm for percutaneous caval filter placement (PCFP) in elderly patients. Neck arthritis, patient anxiety, access site thrombosis or fecal/urinary incontinence complicating jugular or femoral access may require alternative access sites in this population.

Access via the right arm was chosen for PCFP (VenaTech LP). The indication for PCFP was deep vein thrombosis, a history of pulmonary embolism, and a contraindication to anticoagulant therapy. Ultrasound-guided puncture was performed after diameter measurement of the arm veins (Ø_AV). The filter was inserted with standard imaging procedures. Procedural difficulty was graded and compared with Ø_AV and the angle from the arm vein to the superior vena cava (α_AV/SVC).

Over 2 years, 16 patients (14 women, 2 men) with an average age of 90 years (range 79–97 years) were included in the study. The average Ø_AV value of the basilic or brachial veins was 4.2 mm (range 3.0–5.1 mm). The minimal Ø_AV for successful access was determined after the first 15 patients. No hematoma occurred at the puncture sites. The average α_AV/SVC value was 62° (range 29°–90°). Arm access was possible in 12 of 16 patients (75%) with Ø_AV ≥ 3.5 mm and α_AV/SVC ≥ 29°. Every procedure via the arm was graded “easy” by the operator, regardless of angulation values. Femoral access was used in one case due to the impossibility of traversing the heart (patient no. 2), and jugular access was used in 3 of 16 (19%) patients due to puncture failure (patient no. 4), small Ø_AV (3 mm) (patient no. 6), and stenosis of the distal right subclavian vein (patient no.16), respectively.

PCFP via the arm can be routinely accomplished in patients older than 75 years, provided Ø_AV ≥ 3.5 mm, and α_AV/SVC ≥ 29°.