In Reply to: Re: Case 1097_01 -- Gonadal vein placement of inferior vena cava filter posted by Charles P. Semba on October 21, 1997 at 12:16:54:
I am sorry in advance for the somewhat sarcastic tone, but honestly, I am chagrined to see a *Radiologist* so mystified and/or excited by such a basic mistake.
#1,2. I have seen surgeons do this. I have also seen them repeat the trick in large lumbar veins. As for the proposed misdiagnoses, I have also heard "its the 12fr filter, its supposed to look small." This sort of performance and analysis might be within the range of a surgoen, but as far as I am concerned, for a Radiologist to place the filter in a gonadal vein would be due to an inexcusable breach in basic technique, and for him/her to fail to recognize it once done would be beyond unthinkable.
3. I do believe that IJ approach is the preferred one, due to the problem with CFV thrombosis. Pre-procedure cavography is mandatory in order to insure intraval position, size the cava, and locate the renal veins. Flouroscopy and quality angiography are what separate us from the lower animals, and I am absolutely flabbergasted to see a presentation on the SCVIR site that needs to ask the question. Given adequate venography, and technique sufficient to preserve wire position in a structure the size of the IVC, gonadal vein placement should be impossible.
4. Surgeons use Meditech filters; see comments 1,2 above.