Article
IVC Filter Placement Steps
Dr. Chris Beck • Updated Jan 2, 2024
IVC filter placement is a minimally invasive procedure used to prevent pulmonary embolism by capturing blood clots before they reach the lungs. The procedure involves several key steps: first, the patient is positioned appropriately, and local anesthesia is administered. Next, a catheter is inserted through the groin or neck into the inferior vena cava, guided by fluoroscopy or other imaging techniques. The filter is then carefully positioned in the lower vena cava to trap any clots. IVC filter placement is commonly performed in patients at high risk of blood clots, providing an effective solution for preventing severe complications such as pulmonary embolism. This procedure is typically well-tolerated and offers a life-saving intervention with minimal recovery time.
Table of Contents
Pre-Procedure Prep
IVC Filter Placement Steps
Post-Procedure
Pre-Procedure Prep
IVC Filter Placement Indications
IVC filter 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
Pre-Procedural 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
Featured Podcast
Episode # 462 • 09 Jul 2024
IVC Filter Retrieval: Tips & Technique
In this episode of the Back Table Podcast, interventional radiologist Dr. Noor Ahmad discusses his algorithm for complex inferior vena cava (IVC) filter retrievals and reviews several cases that utilize various retrieval tools.
This podcast is supported by
IVC Filter Placement Steps
Antibiotic
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
IVC Filter Placement Complications
• Access site bleeding or thrombosis
• IVC thrombosis
• Filter issues: perforation, migration, embolization, fracture
• Infection
• Misdeployment
• Bleeding
• Air embolism
IVC Filter Placement Post Op Care
• Important to have system in place for follow up and potential filter retrieval
• 1 hour recovery
Additional resources
[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
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