Why use ivc filter

How do I prepare for an inferior vena cava filter placement? Talk with your healthcare provider about how to prepare for your surgery. Your healthcare provider will explain the procedure to you. Ask any questions you may have.

You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is not clear. Talk with your provider about the type of IVC filter that you will have. Some filters can be taken out when your risk of DVT is lower.

Others are meant to stay in your IVC permanently. Tell your provider about all the medicines you take. This includes over-the-counter medicines such as aspirin and all prescription medicines. It also includes herbs, vitamins, and other supplements. You may need to stop taking some medicines before the surgery, such as blood thinners.

Smoking can delay healing. Talk with your provider if you need help to stop smoking. Before the procedure, make sure to tell the healthcare team if you: Have any allergies Have had any recent changes in your health, such as a fever Are pregnant or think you might be pregnant Have ever had a problem with sedation Follow any other instructions from your provider.

What happens during an inferior vena cava filter placement? A typical procedure may go like this: An IV intravenous line will be put in your arm or hand before the procedure starts. This will make you relaxed and sleepy during the procedure. Hair in the area of your procedure may be removed. The area may be numbed with a local anesthesia. Your doctor will make a small incision in this region to access a major vein leading to the IVC. A long thin tube catheter will be inserted into this vein.

Using continuous X-rays fluoroscopy , this tube will be moved up into the IVC. X-ray dye contrast material may be sent through into the catheter. This helps show the IVC clearly on the X-rays.

Your doctor will release the filter into the IVC. IVC filters can be used to prevent or manage pulmonary emboli and deep vein thrombosis DVT , and can be temporary or permanent.

The shape of an IVC filter resembles that of an umbrella, and it functions in a similar way. The interventional radiologist will insert a 3 mm plastic tube called a sheath into the base of your skull or your groin.

They will guide the sheath to the blood clot in the inferior cava vein, which is where the IVC filter will be placed. If you receive a temporary IVC filter, the interventional radiologist will remove the filter after the necessary period of time has passed.

To remove the IVC filter, the interventional radiologist will insert a long plastic tube and a goose-neck system like a miniature lasso as before and use this to remove the IVC filter. One large cohort in which this indication has been called into question is the trauma patient population. In these patients, recent literature has found no mortality benefit of IVC filtration despite a high degree of variability in utilization across hospitals.

Furthermore, poor retrieval rates have been observed in the trauma population, along with an increased risk of DVT associated with IVC filter usage.

At present, there is a limited body of evidence-based literature to support the high utilization rates for IVC filters. The patients were randomized to a control group composed of those on anticoagulation alone versus a group on anticoagulation plus an IVC filter. However, all patients in both studies were treated with anticoagulation, the standard of care for VTE, which limited interpretation of the data given that the current clinical role for IVC filters is mainly for patients with contraindications to anticoagulation.

Growing skepticism surrounding the benefits of IVC filter use has further magnified this void in evidence. At present, most data surrounding IVC filters are limited to observational and retrospective analyses from single centers or national public databases, which have shown conflicting results.

The conclusions from studies in which a positive benefit has been identified remain guarded and continue to suggest that prospective data are warranted to confirm these results. PRESERVE is an ongoing, large-scale, multispecialty, prospective clinical study with a target enrollment of 2, patients and is being sponsored by the Society of Interventional Radiology and Society for Vascular Surgery with the goal of evaluating the use of IVC filters and the related follow-up treatment in the United States.

Figure 1. IVC venogram demonstrates a tilted IVC filter with the apex and hook of the filter embedded within the wall of the vena cava. This has led to extremely high uncertainty about the appropriate usage of IVC filters among medical practitioners.

Increased awareness of these complications has been highlighted by both the FDA safety communication as well as the medical literature. Figure 2. Spot radiograph of the abdomen demonstrates an IVC filter with multifocal fractures. One fractured leg can be seen in the extra-vascular space within the retroperitoneum. For these reasons, methods or designs to mitigate filter-associated complications can significantly affect the utilization of IVC filters amid growing public and medicolegal concerns and help justify continued usage despite a paucity of evidence supporting their efficacy.

Such devices may be particularly useful in critically ill or trauma patients, as the presence of an externalized component serves as a visual aid to lessen concerns of poor retrieval rates in this population. At present, the Angel catheter Bio2 Medical, Inc. Although early experience with the Angel catheter has been promising, recent reports have highlighted cases of filter fracture with subsequent complex retrieval associated with the device, suggesting that temporary filters are not immune to the complications of its retrievable or permanent counterparts.

Braun , which requires interventionalists to remove the hook percutaneously via an endovascular procedure. After the procedure your vital signs and the puncture site will be monitored for a few hours. You can go home the same day with instructions on your blood thinners. Minimal bruising and discomfort may exist in the puncture site.

Whether your surgeon has placed a temporary or permanent IVC filter, it is important that you follow up routinely. In some situation it may be recommend that the filter be removed. The filter may be removed if you are able to take blood-thinning medications or if you are no longer considered at high risk of PE.