IVC Filter Insertion/Retrieval

An inferior vena cava (IVC) filter is a medical device implanted into the inferior vena cava, which is the large vein that carries deoxygenated blood from the lower body to the heart. This device is typically constructed from biocompatible materials such as stainless steel, titanium, or nitinol, and is designed to prevent thromboembolic events by capturing emboli that originate from deep vein thrombosis (DVT) in the lower extremities, thereby averting pulmonary embolism (PE).

The IVC filter is generally indicated for patients who have contraindications to anticoagulation therapy, have experienced recurrent venous thromboembolism (VTE) despite adequate anticoagulation, or are undergoing surgical or high-risk procedures where there is a significant risk of thromboembolic complications.

There are two main types of IVC filters: permanent and retrievable. Permanent filters are designed to remain in place indefinitely, whereas retrievable filters are designed for temporary use and can be removed once the risk of PE has diminished.

The implantation procedure is minimally invasive and is usually performed under fluoroscopic or ultrasound guidance. Access is typically achieved via the femoral or jugular vein, where a delivery catheter is introduced and advanced to the IVC. Upon reaching the desired location, the filter is deployed, expanding to anchor itself against the vessel walls without obstructing blood flow.

Complications associated with IVC filters can include filter migration, penetration of the vena cava wall, thrombosis at the filter site, and difficulties with retrieval. Therefore, patient selection, proper implantation technique, and post-implantation monitoring are critical to optimizing outcomes and minimizing risks.

A&I Protocol

IVC Filter Insertion preparation and exam:

Patient is lying supine on the angiography table, with the patient's head and neck supported by a square sponge and head turned to the left with right internal jugular vein for access.
Sterile preparation of set up and IVC Filter device.
Seldinger technique is used to access the right internal jugular vein under ultrasound guidance.
The wire is advanced and directed down the superior vena cava (SVC) and inferior vena cava (IVC), using fluoroscopy guidance.
A DSA run is performed in the Inferior Vena Cava to check the patency of the vessel.
The sheath in the neck is removed and increasing sizes of dilators are introduced. This is followed by the long sheath for the IVC Filter.
The IVC Filter is prepared and inserted through the long sheath.
When the IVC Filter is in the inferior vena cava, the device is slowly deployed.
A final DSA run is performed to show the IVC filter in the inferior vena cava.
The sheath and guidewire are removed and the neck is cleaned and dressed.

IVC Filter Retrieval preparation and exam:

Patient is lying supine on the angiography table, with the patient's head and neck supported by a square sponge and head turned to the left with right internal jugular vein for access.
Sterile preparation of set up and IVC Filter retrieval device.
Seldinger technique is used to access the right internal jugular vein under ultrasound guidance.
The wire is advanced and directed down the superior vena cava (SVC) and inferior vena cava (IVC), using fluoroscopy guidance.
A DSA run is performed in the Inferior Vena Cava to check the integrity of the IVC Filter. If the IVC Filter is full of clot, then the procedure is abandoned. If the IVC Filter is clear of clot, then the procedure continues.
The sheath in the neck is removed and increasing sizes of dilators are introduced. This is followed by the long sheath for the IVC Filter retrieval device.
The IVC Filter retrieval device is prepared and inserted through the long sheath.
When the IVC Filter retrieval is in the inferior vena cava, the wire loops are opened and closed to attempt to catch the hook of the IVC Filter.
Once the wire loops catch the hook, the retrieval sheath is advanced over the entire IVC Filter device (the hooks will detach from the IVC wall), and the IVC Filter device is removed.
A final DSA run of the IVC is performed to exclude any damage to the walls of the IVC or any potential residual clots.
The sheath and guidewire are removed and the neck is cleaned and dressed.

Fluoroscopy of an IVC Filter retrieval via right jugular vein access.

IVC Filter Insertion/Retrieval

A&I Protocol

References