IVC Filter Placement

The inferior vena cava (IVC) located in the abdomen is the largest vein in the body. It carries impure blood from the legs and other parts of the lower body back to the heart and then sends this blood to the lungs, through the pulmonary arteries, for purification. A blood clot (embolus) that forms in the legs (deep vein thrombosis) can travel through this path and block the pulmonary arteries (a pulmonary embolism), which can be life-threatening.

IVC filter placement is a procedure in which a small filtering device is placed into the IVC to help trap a blood clot that has broken loose from the legs to prevent it from reaching the lungs. In this way, IVC filters help reduce the risk of pulmonary embolism. They allow the continuous flow of blood around the captured clot.

Indications

IVC filter placement is indicated for patients who cannot be given or do not respond to standard medical therapy such as blood thinners - medicines that prevent the formation of blood clots.

Below are conditions that may prevent the use of blood thinners:

• History of developing blood clots
• Individuals who are immobile
• Individuals diagnosed with deep vein thrombosis (DVT) and previous pulmonary embolism (PE)
• Risk of falls due to age or other medical issues
• Recent spinal cord or brain surgery
• Hemorrhagic stroke
• Brain bleed
• Recent trauma
• Digestive tract bleeding

Preparation

Preparation for IVC filter placement may involve the following steps:

• A thorough history and physical examination
• Routine blood work and imaging
• Informing your doctor of any medications or supplements you are taking
• Refraining from blood thinners, aspirin, or NSAIDs, if indicated
• Informing your doctor of any allergies to medications, anesthesia, or contrast dye
• Refraining from solids or liquids at least 8 hours prior to the procedure
• Informing your doctor of any recent illnesses or other medical conditions, or if you are or may be pregnant
• Arranging for someone to drive you home after the procedure

Surgical procedure

IVC filter placement is usually performed under local anesthesia using a contrast dye by an interventional radiologist. Contrast is a special dye that makes it easier for your physician to view your internal organs during the procedure. An interventional radiologist is a physician who specializes in image-guided procedures.

During the procedure, your physician will make an incision in a vein either in your groin or neck. A thin, flexible tube called a catheter is inserted into this vein. The catheter is then gently moved into the inferior vena cava under fluoroscopic guidance (real-time x-ray). A collapsed IVC filter is sent along with the catheter. Once the filter is in place and expanded, the catheter is then removed. The incision on your groin or neck will be closed and bandaged. The procedure usually takes about 30 minutes.

Postoperative care

Following the procedure, you should be able to go home the same day after a few hours of observation in the recovery room. You may feel sore or have some swelling at the catheter insertion site. Medications are provided as needed to address these. Instructions on incision site care and bathing will be provided to keep the wound clean and dry. You should be able to resume your normal activities in a week or two but should refrain from lifting heavy weights or engaging in strenuous activities for a defined period. A follow-up appointment will be scheduled by your interventional radiologist to monitor your progress.

Risks and Complications

Risks and complications associated with IVC filter placement may include:

• Allergic reactions to the contrast dye or anesthesia
• Infection/injury at the site of catheter insertion
• Damage to the vein
• Migration of the IVC filter
• Excessive bleeding
• The IVC filter itself may cause a clot
• Rarely, clots may pass through the IVC filter

Summary

IVC filter placement is a minimally invasive procedure in which a small metal device is placed within the inferior vena cava to prevent blood clots from moving through the blood into your heart or lungs. The filter helps to protect you from a life-threatening pulmonary embolism if you have a deep vein thrombosis.