Placement of the VenaTech LP Caval Filter in the Elderly: Feasibility and Clinical Benefits of Insertion Via the Arm Alain F. Le Blanche, 1 Eric Pautas, 2 Isabelle Gouin, 3 Audrey Bagu ¨e ´ s, 4 Franc ¸ ois Piette, 2 Pascal Chaibi 2 1 Department of Radiology and Medical Imaging, Hôpital Universitaire Charles Foix – Assistance Publique - Hôpitaux de Paris, UniversitØ de Paris 6-7, avenue de la RØpublique, 94205 Ivry-sur-Seine Cedex, France 2 Department of Internal and Geriatric Medicine, Hôpital Universitaire Charles Foix – Assistance Publique - Hôpitaux de Paris, UniversitØ de Paris 6-7, avenue de la RØpublique, 94205 Ivry-sur-Seine Cedex, France 3 Department of Thrombosis and Hemostasis Investigation, Hôpital Universitaire Charles Foix – Assistance Publique - Hôpitaux de Paris, UniversitØ de Paris 6-7, avenue de la RØpublique, 94205 Ivry-sur-Seine Cedex, France 4 Department of Medical Equipment, Hôpital Universitaire Charles Foix – Assistance Publique - Hôpitaux de Paris, Paris 6-7, avenue de la RØpublique, 94205 Ivry-sur-Seine Cedex, France Abstract Purpose: 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 throm- bosis or fecal/urinary incontinence complicating jugular or femoral access may require alternative access sites in this population. Methods: 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 con- traindication 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 (a AV/SVC ). Results: Over 2 years, 16 patients (14 women, 2 men) with an average age of 90 years (range 79–97 years) were in- cluded 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 mini- malø AV for successful access was determined after the first 15 patients. No hematoma occurred at the puncture sites. The average a 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 a 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 (pa- tient no.16), respectively. Conclusion: PCFP via the arm can be routinely accom- plished in patients older than 75 years, provided ø AV ‡ 3.5 mm, and a AV/SVC ‡ 29°. Key words: Arm—Caval filter—Deep vein thrombosis— Elderly—Percutaneous access In the elderly, the annual incidence of deep vein thrombosis (DVT) increases with age from 2.2& between 70 and 74 years, to 3.1& between 85 and 89 years [1]. In a geriatric population, the 1-year mortality rate due to pulmonary embolism(PE)is39% [1].TheincidenceofDVTis5times higherinpatientsolderthan60yearsofage(0.27%)thanin the general population (0.05%), and the incidence of PE is also 5 times greater above the age of 60 years (0.11%) than it is in the general population (0.02%) [1, 2]. In long-term care units, the annual incidence rate of DVT is 15.2% [3]. The risks associated with anticoagulant therapy, the first- line treatment of venous thromboembolic disease (VTD), increase with age, the rate of complications due to antico- agulation being close to 14% after the age of 72 years, Correspondence to: A. F. Le Blanche, M.D., PhD., Department of Radi- ology and Medical Imaging, CHU - Amiens Picardie – UPJV, 1 place Victor Pauchet, 80054 Amiens Cedex, France; email: le_blanche.alain@ chu-amiens.fr ª Springer Science+Business Media, Inc. 2005 Published Online: 20 July 2005 CardioVascular and Interventional Radiology Cardiovasc Intervent Radiol (2005) 28:813–817 DOI: 10.1007/s00270-004-0119-0