Inferior Vena Cava (IVC) Filter

What is IVC filter placement procedure?

• Venous thromboembolism (VTE), deep vein thrombosis (DVT) and pulmonary embolism (PE) affects 1 to 2 individuals per 1,000 annually
• These are the leading cause of preventable hospital death
• DVT is more commonly diagnosed than PE
• But mortality from PE twice that of DVT
• Anticoagulation is the preferred treatment for VTE
• Inferior vena cava (IVC) filter is an important therapeutic option in the management of selected patients with VTE – anticoagulation contraindicated, complications, or fails to protect.

What are the types of IVC filters?

Permanent IVC filter:

• The Long-term need for mechanical prophylaxis against PE
• Absolute contraindications to anticoagulation

Temporary IVC filter:

• Temporary risk of PE
• Contraindication to anticoagulation resolved 

What are the indications for IVC filter placement?

Classical indications:

• Absolute contraindication to anticoagulation
• A Complication of anticoagulation resulting in cessation of therapy
• Failure of anticoagulation
• Propagation/progression of DVT during therapeutic anticoagulation

Expanding Indications with DVT:

• Iliocaval DVT or large, free-floating proximal DVT
• Difficulty establishing therapeutic anticoagulation
• Massive PE treated with thrombolysis
• Chronic PE treated with thromboendarterectomy
• Thrombolysis for iliocaval DVT
• VTE with limited cardiopulmonary reserve
• Recurrent PE with a filter in place
• Poor compliance with anticoagulation
• High risk of complication of anticoagulation

Expanding indications without DVT:

• Trauma patient with a high risk of VTE
• A surgical procedure inpatient high risk for VTE
• Medical condition high risk of VTE

What are the risks of IVC filter placement?

• Bleeding manifestations
• Infection
• Allergic reaction to medications and dye used during the procedure
• Blood clots that travel through lungs
• Blood vessel damage at the insertion site
• Legs swelling due to blockage of blood vessel
• Respiratory related problems
• Death

What are the complications of IVC filter placement?

• Thrombosis
• Pulmonary embolism
• Migration of IVC filter
• IVC perforation
• Filter fracture

How is IVC filter placement done?

Understanding the procedure

Before the procedure:

Dietary instructions:

Follow instructions by your doctor about hydration, which may include:

• Stop heavy meals or processed food before 8 hours of the procedure
• Stoplight meals before 6 hours
• Stop drinking milk or carbohydrate drink before 6 hours
• Stop drinking water or clear fruit juice before 2 hours

General instructions:

• List all the current medications and supplements used
• Any allergies towards the medications should be reported
• Stop aspirin and ibuprofen if you are taking previously because these can thin your blood. Do not take before the procedure
• Changing /stopping the regular medication, especially if the patient is diabetic
• Antibiotic is given to prevent infection
• Blood samples are taken for clinical investigations
• Vitals are checked

During the procedure:

• Small insertion is made in the neck or groin area
• The catheter will be inserted and directed towards inferior vena cava using X rays imaging (Contrast dye is inserted in a catheter to show IVC clearly)
• IVC filter is inserted through the catheter will be released, expanded and attached to IVC
• The catheter will be removed
• A bandage is placed over the catheterized area to stop bleeding and infection.

After the procedure:

• Vitals such as Blood pressure, heart rate, temperature, respiration rate, blood oxygen level will be monitored.
• You will be instructed to rest in the ICU for 24 hours.
• Patient hospital stay will be 2 to 4 days.
• If the catheter insertion is at the groin area, you may ask not to bend or cross your legs
• Infections and bleeding manifestations are checked at the insertion site
• You will be instructed to keep hydrated that will help you in washing off the contrast dye
• Blood tests, Chest X-ray and Electrocardiogram(ECG), Echocardiogram will be done

What is the uniqueness of IVC filter placement by Dr C Raghu?