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.
IVC FILTER
IVC FILTER 2

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?



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Copyright © 2019, Dr C Raghu. All rights reserved.
Designed & Developed by R R Deepak Kambhampati.