Vena cava filter

Vena cava filter is an endovascular device which is typically placed in the infrarenal inferior vena cava (IVC) to prevent pulmonary embolism in selected patients. This procedure is most often performed by interventional radiologists under fluoroscopic guidance.

  • contraindication to anticoagulation, eg active gastrointestinal bleed or recent neurosurgery
  • pulmonary embolism despite anticoagulation
  • poor patient compliance with antiocoagulation treatment
  • large iliocaval or floating IVC thrombus “widow-maker” thrombus

A temporary (i.e. retrievable) vena cava filter is typically placed for a short duration, usually weeks to a few months. The design of the temporary filter permits subsequent endovascular retrieval. In certain patients vena cava filters are left in situ indefinitely, these devices may be called permanent filters.

Circumstances when a vena cava filter cannot be placed are rare.

Preprocedural evaluation
  • review all available imaging to establish indication for the procedure; previous studies can help assess IVC patency, size and presence of anomolies such as duplicated IVC and circumaortic renal vein
  • whilst departmental practices vary, interventionists often place IVC filters without stopping anticoagulation therapy
  • obtain informed consent for the procedure
  • arrange analgesia and sedation according to patient comfort
Positioning/room set up

The procedure is usually performed in the angiography suite with the patient in supine position. Regular monitoring of the vital signs by a suitably trained staff member is recommended during the procedure. Clean skin with antiseptic solution and drape to maintain sterility for the procedure.

Equipment
  • ultrasound machine
  • 18 gauge needle. Alternatively 22 or 21 gauge needle and a micro-puncture access set
  • 0.035" vascular guide wire
  • multisidehole straight or pigtail catheter
  • commercially available vena cava filter set
Technique

Specific technical steps may vary according to personal preference and on the type of filter being used. Generally, internal jugular or femoral vein is punctured under ultrasound guidance and a guide wire is placed in the IVC. A venogram is obtained by injecting contrast through a multisidehole catheter positioned in lower IVC or distal common iliac vein. The venogram is used to reassess the IVC for patency, size and anomalies. The location of the renal veins is often indicated by the presence of contrast reflux or flow voids. The venous access is dilated using a dilator. The vena cava filter is subsequently deployed in a suitable location through a delivery sheath, typically the infra-renal IVC. Another venogram is obtained to ensure satisfactory deployment of the filter. The delivery sheath is removed. Haemostasis is secured using manual compression.

Post procedure care

Regular monitoring of vital signs is performed for the first few hours after the procedure.

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Article information

rID: 22435
Synonyms or Alternate Spellings:
  • IVC filter
  • Inferior vena caval filter

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Cases and figures

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    Case 1: filter placements
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    Case 2: 3D on CT
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    Case 2: CT
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    Trapease IVC filter
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    Case 4: venography
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    Case 5: Simon nitinol
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    Case 6: Greenfield
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    Case 7: Vena tech IVC filter
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    Case 8: Mobin-Uddin filter one in IVC and one in liver
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    Case 9: fractured filter limb
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    Associated severe...
    Case 10: Günther Tulip filter
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