IVC Filter Placement

IVC Filter Placement

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Pre-Procedure

Indications:
Guidelines vary

Society of Interventional Radiology (SIR) Guidelines:
Therapeutic (documented thromboembolic disease)
• Contraindication to anticoagulation
• Complications to anticoagulation
• Failure of anticoagulation
• Recurrent PE despite adequate therapy
• Inability to achieve/maintain adequate anticoagulation
• Propagation/progression of DVT during therapeutic anticoagulation
• Massive PE with residual DVT in patient at risk for further PE
• Free-floating iliofemoral or IVC thrombus
• Severe cardiopulmonary disease and DVT
Prophylactic placement
• Severe trauma without DVT
• Closed head injury, spinal cord injury, multiple long bone fractures
• High risk patients (immobilized or ICU)

American College of Chest Physicians (ACCP)
• Contraindication to anticoagulation
• Massive PE with DVT

Relative Contraindications:
• Uncorrectable severe coagulopathy
• Bacteremia or untreated infection

Preprocedural evaluation:
• H&P
• GFR - if renal insufficiency a concern, can use CO2 or IVUS
• Review prior imaging: is a filter already present, cava size, IVC duplication/atresia, position of renal veins

Procedure

No routine antibiotic prophylaxis recommended

Venous access:
• Jugular vs. Femoral
• Primarily operator preference

Choose filter type: many options, both retrievable and permanent
Over the wire, place sheath. Size of sheath depends on filter

Perform cavogram (15 mL/s for 30 mL)
• Cava size, variant anatomy, IVC thrombus
• Position and number of renal veins

Filter deployment
• Will vary based on filter specifics
• Patient anatomy and extent of clot
• Unsheath filter without advancing or retracting the filter

Post filter cavogram
• Document position/tilt
• If jugular approach, avoid contact with filter which can alter positioning
Remove sheath

Post-Procedure

Complications:
• Access site bleeding or thrombosis
• IVC thrombosis
• Filter issues: perforation, migration, embolization, fracture
• Infection
• Misdeployment
• Bleeding
• Air embolism

Postoperative care:
• Important to have system in place for follow up and potential filter retrieval
• 1 hour recovery



Related Procedures

No related procedures.

Step-by-step guidance on how to perform Filter Retrieval. Review tools, techniques, pearls, and pitfalls on the BackTable Web App.
 

References

[1] DeYoung E, Minocha J. Inferior Vena Cava Filters: Guidelines, Best Practice, and Expanding Indications. Semin Intervent Radiol. 2016;33(2):65‐70. doi:10.1055/s-0036-1581088
[2] Mismetti P, Laporte S, Pellerin O, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA. 2015;313(16):1627‐1635. doi:10.1001/jama.2015.3780
[3] Caplin DM, Nikolic B, Kalva SP, et al. Quality improvement guidelines for the performance of inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol. 2011;22(11):1499‐1506. doi:10.1016/j.jvir.2011.07.012
[4] Funaki B. Inferior vena cava filter insertion. Semin Intervent Radiol. 2006;23(4):357‐360. doi:10.1055/s-2006-957026
[5] Decousus H, Leizorovicz A, Parent F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. 1998;338(7):409‐415. doi:10.1056/NEJM199802123380701

Join The Discussion

 

Demos

Demos are not yet available for this procedure.

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Bedside Inferior Vena Cava (IVC) Filter Placement with Intravascular Ultrasound (IVUS)

This demo description is not yet available.

How to Place an IVC Filter

Dr. Valmore Suprenant demonstrates IVC filter placement with a right internal jugular vein approach.

Inferior Vena Cava (IVC) Filter Placement

Dr. Ryne Dougherty demonstrates infrarenal inferior vena cava filter placement

 

Tools

Tools are not yet available for this procedure.

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IVC Filter Compendium

IVC Filter Compendium on BackTable

Easily searchable mobile application that contains information on the more than 20 FDA approved IVC filter devices.

 

Literature

Literature is not yet available for this procedure.

Please check back soon.

Seminars in Interventional Radiology (Jun 2016)

Inferior Vena Cava Filters: Guidelines, Best Practice, and Expanding Indications

A review of the current guidelines and expanding indications for IVC filter placement.

Seminars in Interventional Radiology (Jun 2016)

A Dedicated Inferior Vena Cava Filter Service Line How to Optimize Your Practice

Retrievable inferior vena cava filters (rIVCFs) are increasingly left in place beyond their indicated usage largely due to poor clinical follow-up. A dedicated IVC filter service line or clinic can improve filter retrieval rates.

Seminars in Interventional Radiology (Dec 2006)

Inferior Vena Cava Filter Insertion

Techniques for placing an IVC filter, instrument selection, and potential complications.

 

Podcasts

Podcasts are not yet available for this procedure.

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Dr. Robert Ryu

Dr. AJ Gunn

Robert Ryu and AJ Gunn discuss building a filter retrieval practice, equipment preferences, and challenging cases.

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Over-the-Wire IVC Flter Podcast with Dr. David Mobley

Dr. David Mobley

Dr. Michael Barraza

Dr. David Mobley of Columbia University VIR describes his over-the-wire technique to prevent tilting in IVC filter placement, and the advantages of a tilt free delivery.

&

 

Blog Articles

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bt-procedure-feed-arterial-revasculariza

Tips and Techniques For Over-The-Wire IVC Filter Placement

The over-the-wire (OTW) technique for IVC filter placement was designed to improve the deployment and subsequent positioning of IVC filters while minimizing ...

bt-procedure-feed-arterial-revasculariza

Over-The-Wire Technique for IVC Filter Placement

Inferior vena cava (IVC) filters are used prophylactically in patients with contraindications to anticoagulants in order to prevent pulmonary embolism. Compl...