An inferior vena cava filter, or ivc filter, is a small medical device that is used to prevent blood clots from traveling from the legs to the circulation of the lungs. The filter was removed by a loopsnare technique through an internal jugular vein. Care should be taken when advancing a guidewire or imaging catheter through a filter to prevent entanglement. In such patients, anticoagulation should be resumed and ivc filters. Indications, techniques, and results enrico ascer, md, mark gennaro, md, elke lorensen, md, and robert m. Complications of inferior vena cava filters grewal. Inferior vena cava ivc filter placement northwestern medicine.
The thrombus can propagate through the filter leading to a high risk of pulmonary embolism. Used for the prevention of recurrent pulmonary embolism via placement in the vena cava in the following situations. An ivc filter is a small metal device that traps large clot fragments and prevents them from traveling through the vena cava vein to the heart and lungs, where they could cause severe complications such as pain, difficulty breathing, shortness of breath or even death. The inferior vena cava, or ivc, is a large vein in your abdomen that returns blood from your lower body to your heart. During inferior vena cava ivc filter placement, a filtering device is placed within the ivc, a large vein in the abdomen that returns blood from the lower half of the body to the heart. Inferior vena cava filters are implanted scaffolds, usually selfexpanding nitinol, designed to entrap migratory venous thromboemboli. The veinartery relationship alters as the inferior vena cava ascends. This study assessed the clinical feasibility of placement of the titanium greenfield filter within the superior vena cava svc in patients with upper extremity deep venous. The resulting inferior vena cava registry report 2011 showed that the most common reason for filter insertion was preoperatively in patients with deep vein thrombosis or pulmonary embolism 30.
Inferior vena cava thrombosis is a major complication after filter placement. The inferior vena cava is a large vein in the middle of your body. Blood clots in the veins of the legs and pelvis can occasionally travel to the lungs where they may cause a pulmonary embolism or blockage. This chapter discusses the size and shaping parameters for ivc filters, and considers materials that are suitable. The heart then pumps the blood to the lungs to pick up oxygen. Understanding inferior vena cava ivc filter placement. Physical examination revealed grossly dilated veins of the abdomen, chest wall and inguinal areas figure 1.
Inferior vena cava ivc thrombosis associated with filters is not uncommon in clinical practice. We placed temporary inferior vena cava filters to prevent pulmonary thromboembolism in patients with deep vein thrombosis dvt who were presumed to have an increased risk of pulmonary embolism in the perinatal period. They are placed in patients with lower extremity venous thrombosis in whom systemic anticoagulation is contraindicated or unsuccessful in preventing pulmonary embolism. This information will help you get ready for your inferior vena cava ivc filter placement by the interventional radiology department at memorial sloan kettering msk. Natural history of postoperative deepvein thrombosis. Filter if significant amounts of thrombus are trapped within the filter or if the filter snare hook is embedded within the vena cava wall. However, suprarenal extension of the thrombosis to the hepatic segment of the ivc is very rare, particularly in absence of renal or hepatic tumors 11. Guided by xray, this filter was placed in a large vein ivc found in your abdomen.
Veins are the blood vessels that bring oxygenpoor blood and waste products back to the heart. The hook may be snared from above to allow for percutaneous retrieval. However, pulmonary embolism pe remains the second leading cause of perioperative mortality after anastomotic leak, accounting for almost 40% of perioperative deaths after bariatric surgery 1. At two years, 37 patients assigned to the filter group 20. The placement of intracaval filters in an anomalous left. Fluoroscopic images of the 27f micra delivery system traversing the inferior vena cava ivc filter after balloon dilation with a 10. Of the patients who developed a dvt in the ivc filter arm, 46% 26 of. A small catheter tube is placed and with guidance of contrast dye and xray images, the filter is collapsed inside the catheter and removed through the same puncture hole. If there are blood clots in the veins in the legs or pelvis, these could pass up the vena cava and into the lungs. The femoral system allows for placement of the meridian filter via a femoral vein. Removing a retrievable inferior vena cava ivc filter can be extremely difficult with the use of standard techniques if the filter is tilted and embedded in the wall of the ivc. Abdominal varicosities secondary to inferior vena cava filter.
Oct 01, 20 natural history of postoperative deep vein thrombosis. Pdf inferior vena cava filterscurrent role and controversies. There are many device types in the market and in the. In addition, a clot can form on the upper side of the filter and still lead to a pe. The clinical rationale for the sentry bioconvertible inferior vena cava filter for the prevention of pulmonary embolism article pdf available in international journal of vascular medicine 20195. A clinical trial of vena caval filters in the prevention. May 03, 2020 the filter is usually installed in the inferior vena cava, the part of the vein which runs through the abdomen, and it is inserted through a blood vessel in a minor invasive procedure. Rates of pulmonary embolism demonstrated an initial increase and were followed by a reduction in the pennsylvania trauma outcome study and national trauma data bank data sets, with no change in the national nationwide inpatient sample data set. An inferior vena cava filter is a type of vascular filter, a medical device that is implanted by vascular surgeons or interventional radiologists into the inferior vena cava to prevent lifethreatening pulmonary emboli pes. A multicenter trial of vena cava filters in severely injured. The inferior vena cava ivc is a large vein in the middle of the abdomen. Acrsir practice parameter for the performance of inferior. These experiences of using temporary inferior vena cava filters in. Blood clots in the veins of the legs and pelvis can occasionally travel to the lungs where they may cause a.
Balloon dilation of an inferior vena cava filter to. Inferior vena cava filters and postoperative outcomes in. Youll be told how to prepare for your procedure in advance. Inferior vena cava filter misplacement in the right. Rigid endobronchial forceps may be used as a reliable option for removal of embedded ivc filters. The inferior vena cava or ivc is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. Vena cava thrombosis after vena cava filter placement. Inferior vena cava ivc filter retrieval an ivc filter was used to prevent blood clots from moving from the lower part of your body to your lungs. We report such a case in a patient with a gunther filter, successfully treated with urokinase, and we discuss the efficacy and the safety of thrombolytic therapy in such situations.
A procedure called inferior vena cava ivc filter can treat a clot. Placement through a right internal jugular vein is preferable. Until recently, ivc filters were available only as permanently implanted devices. Inferior vena cava filter insertion through the popliteal vein. Apr 21, 2014 venous thromboembolism vte is uncommon 0. Inferior vena cava filters, maythurner syndrome, and vein. An inferior vena cava filter placement is a procedure to place a small filter in the vein. Inferior vena cava filter an overview sciencedirect topics. Vct is a serious complication that can arise weeks to years following vcf placement, but the incidence and risk factors for vct after vcf placement among the chinese population are unclear.
Apr 24, 20 a 46yearold male with diabetes, hypertension, and a history of pulmonary embolism status post placement of a retrievable celect inferior vena cava ivc filter presented to the emergency department with progressively worsening abdominal pain for 1 month. An ivc filter is used to prevent blood clots from moving from the lower part of your body to your lungs. For quality improvement reporting purposes, the definition of ivc penetration by a filter is filter strut or anchor devices extending 3 mm outside the wall of the ivc as demonstrated by ct, venography, or autopsy. Obtaining optimal filter placement endovascular today. Ivc filters are like baskets that are made of many wires. Pdf the clinical rationale for the sentry bioconvertible. Deliver and release filter as described in step 22. Device description the denali vena cava filter is a venous interruption device designed to prevent pulmonary embolism. Inferior vena cava filters duffett 2017 journal of thrombosis and. The ivc returns blood from your lower body to your heart.
Inferior vena cava ivc filter placement is a relatively low risk alternative for prophylaxis against pulmonary embolism in patients with pelvic or lower extremity deep venous thrombosis who are not suitable for anticoagulation. Your inferior vena cava ivc is the major vein that brings oxygenpoor blood from the lower body back to the heart. Early placement of a vena cava filter did not result in a significantly lower incidence of symptomatic pulmonary embolism or death than no placement of a filter. Misplacement of an inferior vena cava ivc filter in a gonadal vein is a rare complication of ivc filter placement.
Although the filter arm did not have any increased incidence of pts, 57 patients with filters developed a symptomatic dvt compared with 41 patients in the control group p 0. Another doppler study at 20th week of gestation showed sequels of recent phlebothrombosis in right lower limb veins, with popliteal vein and superficial femoral vein partially occluded by a thrombus. The inferior vena cava is the large vein through which blood circulation in the abdomen, pelvis or legs return to the heart. Placement and removal of inferior vena cava filters. The use of rigid endobronchial forceps has been described in case reports to remove embedded ivc filters, and the present report describes the use of this. Of the patients who developed a dvt in the ivc filter arm, 46% 26 of 57 patients had associated filter thrombosis. This handout explains what an inferior vena cava filter is and what to expect when you have one placed or removed. We report a case of a filter misplaced in the ovarian vein of a pregnant woman with agenesis of the infrarenal ivc and bilateral lower extremity deep venous thrombosis. Greenfield stainless steel vena cava filter boston scientific. Removing a vena cava filter is usually a simple procedure and is done as an outpatient procedure. There is an increasing trend in the number of ivc filter implantation procedures performed every year. An inferior vena cava ivc filter is a small device that can stop blood clots from going up into the lungs.
Prior to deployment, verify the location of the filter within the sheath using fluoroscopy and confirm that the filter snare hook is 1cm below the lowest renal or is in the intended location in the inferior vena cava. The filter will trap these blood clots and prevent them entering the. Inferior vena cava filter placement during pregnancy. It carries blood from your lower body to your heart and lungs. Summary use of inferior vena cava ivc filters has increased dramatically in recent. Appropriatelyplaced vcfs are designed to reduce the frequency of significant pulmonary embolism pe by trapping emboli arising in the deep veins before they reach the lungs.
Filter penetration penetration of the vein wall by a filter strut with transmural incorporation. Venous thromboembolism vtedeep vein thrombosis dvt and pulmonary embolism peaffects 1 to 2 individuals per 1,000 annually, and it is a leading. Components of some inferior vena cava filter include the tip with a hook, arms short struts, and legs long struts. These filters are reserved for patients who are unable to take bloodthinning medications or for those at high risk for developing recurrent dvt with pulmonary embolism pe. Inferior vena cava filters ivcf are intended to prevent the passage of deep vein thrombosis to the pulmonary arteries. Denali vena cava filter completely redesigned bard filter with advanced filter technology to help prevent movement, tilt and penetration. About your ivc filter the inferior vena cava is the largest vein in your body. An ivc filter is one method to help prevent pulmonary embolism. The inferior vena cava runs posterior, or behind, the abdominal cavity. Meaning vena cava filter use is not associated with rates of pulmonary embolism. Experience of temporary inferior vena cava filters. In an inferior vena cava filter placement procedure, interventional radiologists use image guidance to place a filter in the inferior vena cava ivc, the large vein in the abdomen that returns blood from the lower half of the body to the heart blood clots that develop in the veins of the leg or pelvis, a condition called deep vein. Ivc filters are removed through a vein in the neck. The denali filter can be delivered via the femoral and jugularsubclavian approaches.
Vital signs showed an o2 saturation of 90% on room air and a respiratory rate of 24 breathsmin. Placement of an inferior vena cava ivc filter may be a required for a deep vein thrombosis dvt. It is formed by the joining of the right and the left common iliac veins, usually at the level of the fifth lumbar vertebra. Vcf vena cava filter vte venous thromboembolism mechanism of action. What is inferior vena cava filter placement and removal. The followup of these patients may be carried out at other institutions, and complications can be observed as incidental findings in patients examined for reasons unrelated to the vena cava filter implantation e. Inferior vena cava filters, maythurner syndrome, and vein stents. Less common complications include small pieces of the metal frame of the filter breaking off. The overall incidence of vena cava thrombosis vct among the individuals fitted with currentgeneration filters varies from 20% to 30%. However, suprarenal extension of the thrombosis to the hepatic segment of the ivc is very rare. Guided by xray, this filter is placed in a large vein ivc. Perforation of inferior vena cava by inferior vena cava. Inferior vena cava an overview sciencedirect topics. Computed tomography imaging of vena cava filter complications.
Anticoagulation was avoided by introducing a birds nest filter into the inferior vena cava via the common femoral vein. Vena cava filters varicose veins nyc nj spider veins. Inferior vena cava filter for dvt dvt must be treated to restore blood flow in a vein and to reduce the risk of complications. The side rails attached to the filter struts anchor the filter within the vena cava see fig. Use of vena cava filters and venous access devices. Denali vena cava instructions for use manual pdf download. Inferior vena cava filter insertion through the popliteal.
Spanish multicenter real life registry of retrievable. Indications for and use of inferior vena cava filters in. In some cases, a vena cava filter may be inserted into the vena cava the large vein which returns blood from the body to the heart of patients who cannot take medication or if blood thinners are not working. The veins are the tubes that return blood from the body tissues to the heart and lungs. A blood clot that forms in the deep veins of the legs is called deep vein thrombosis dvt. Other risks include, movement of the filter 018%, fracturing or breaking up of the filter 210%, infection of the filter very rare and parts of the filter penetrating through the wall of the vein inferior vena cava, 041%. Before the filter is inserted, a radiologist injects contrast dye which is used to determine the best placement. Implantation of a permanent or retrievable filter in the inferior vena cava ivc is becoming an increasingly popular option for patients at risk of deep vein thrombosis dvt.
Due to the high risk of peripartum pulmonary embolism, an inferior vena cava filter ivcf placement was proposed. A multicenter trial of vena cava filters in severely. At its commencement the inferior vena cava lies behind the common iliac artery fig. A before inferior vena cava ivc filter deployment, an inferior vena cava venogram was performed and showed classic anatomy. Inferior vena cava ivc filter placement johns hopkins. Information and consent for inferior vena cava ivc filter placement your physician has requested that we evaluate you for possible placement of an inferior vena cava filter ivc filter. Their effectiveness and safety profile is well established. Inferior vena cava thrombosis abstract thrombosis of the inferior vena cava ivc is an underrecognized entity that is associated with signi. During inferior vena cava ivc filter placement, a filtering device is placed within the ivc, a large vein in the abdomen that returns blood from the lower half of. When the filter is placed in your ivc, the blood flows past the. The renal veins are indicated by the flow filling defects caused by. Acute thrombosis of a vena cava filter with a clot above the. Vena cava filters vena caval filters are used in patients with either a very high risk either for forming or being treates for deep vein clots.
Lack of randomized controlled trials to guide thromboprophylaxis after bariatric surgery. Correct placement of a greenfield filter i 0 a leftsided vena cava requires recognition of this anomaly. Inferior vena cava filter thrombosis and suprarenal caval. This vein also runs alongside the right vertebral column of the spine. The ivc brings blood from the lower part of your body back to the heart. Experience of temporary inferior vena cava filters inserted in the perinatal period to prevent pulmonary embolism in pregnant women with deep vein thrombosis. Dvt deep vein thrombosis, ivc inferior vena cava retrievable inferior vena cava ivc filters are designed to be removed if the filter is no longer needed. A 46yearold male with diabetes, hypertension, and a history of pulmonary embolism status post placement of a retrievable celect inferior vena cava ivc filter presented to the emergency department with progressively worsening abdominal pain for 1 month. Multiple anomalies of the inferior vena cava have been described.
You may need to stay in the hospital for a day or longer. The inferior vena cava is the result of two major leg. In absence of a congenital anomaly, the most common cause of ivc thrombosis is the presence of an unretrieved ivc. Enabling the percutaneous endovenous intervention of deep vein thrombosis with a single venous approach in a single session hyoung ook kim, m.
In these patients, interruption of the inferior vena cava ivc is considered. It gets to the lung via the big vein in the abdomen, called the inferior vena. Iliac vein or vena cava vein blockage or narrowing prevents blood flow from getting out of the legs since these are the major exit sites for this blood to get back to the heart. Removing blockages from these veins is possible with techniques that allow one to place a dilating balloon and stent metallic support device inside the narrowed vein. Inferior vena cava filter placement and removal during inferior vena cava ivc filter placement, a filtering device is placed within the ivc, a large vein in the abdomen that returns blood from the lower half of the body to the heart. The denali filter has been clinically tested in the largest and longest ide filter study. Bedside vena cava filter placement with intravascular ultrasound.
Carroll and moll ivc filters and vein stents e385 filters in patients who have a new or worsening clot while on blood thinners, whereas the american college of chest physicians does not recommend an ivc filter in. Third, the right gonadal vein drains directly into the ivc at an acute angle just inferior to. Jugularsubclavian vein approach instructions for use. The filter is placed in the vena cava, which is the large vein in the abdomen that brings blood back from the legs and pelvis, towards the heart. Inferior vena cava filter thrombosis and suprarenal caval stenosis a double whammy mohamad alkhouli, md, irfan sha. Although lowerlimb deep venous thrombosis dvt has been found to be responsible. Its walls are rigid and it has valves so the blood does not flow down via gravity. The filter may slow or stop the blood flow in the inferior. They are also used in patients that already have a deep vein clot, in order to prevent that clot from going to the lungs and lodging there. A 43yearold man with a medical history of multiple deep vein thrombosis and right inferior vena cava ivc filter placement, was evaluated for shortness of breath and venous claudication.
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