Inferior Vena Cava (IVC) Filter Placement

What is an inferior vena cava (IVC) filter placement?

An inferior vena cava (IVC) filter placement is an interventional radiology procedure to place a filter in the inferior vena cava, the large vein in the abdomen that returns blood from the lower body to the heart.

Why do you need an IVC filter placement?

In a condition called deep vein thrombosis (DVT), blood clots that develop in the veins of the leg or pelvis occasionally break up and large pieces of the clot can travel to the lungs.

The procedure uses an IVC filter to trap large clot fragments and prevents them from traveling through the vena cava vein to the heart and lungs, where they could cause severe complications or even death.

Who should not undergo an IVC filter placement?

This procedure is not advisable for pregnant women.

What are the risks and complications of an IVC filter placement?

This interventional procedure is associated with risks such as:

• Pain or discomfort at the catheter insertion site
• Bleeding at the site
• Injury to a blood vessel
• Infection of the blood stream

Possible complications

Some possible complications of the procedure are:

• The IVC may become blocked after the placement of the filter. As blockage of the IVC is a gradual process, it usually will not cause any symptoms. You will develop veins around the blocked area and these veins will allow blood flow from your lower body. However, this results in the risk of a clot passing through these veins, bypassing the filter, and reaching your lungs.
• The filter may shift in position after placement. If your femoral vein (located in your groin) was used for the procedure, there is the possibility that the vein may become blocked. This may result in leg swelling and may require intravenous blood thinners or the use of blood clot dissolving drugs given into the IVC.
• The possibility of experiencing a recurrent pulmonary embolism due to clot material passing through the small openings in the filter.

Other associated risks include:

• An allergic reaction to the X-ray contrast material
• Reduced kidney function
• Aspiration (inhaling food or liquid into your lungs) or respiratory depression due to the medications used for conscious sedation

There may also be other unpredictable risks in this procedure resulting in death.

How do you prepare for an IVC filter placement?

Prior to your procedure, your doctor may do the following:

• Test your blood to check your kidney function and to determine if your blood clots normally
• Ask about your medications
• Instruct you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners
• Instruct you not to eat or drink anything after midnight before your procedure, and which medications you may take in the morning

It is important to let your doctor know:

• All the medications you take, including herbal supplements
• About any allergies, especially to local anaesthetic, general anaesthesia, or contrast materials
• About recent illnesses or other medical conditions
• If you are pregnant, to avoid exposing the foetus to possible radiation (e.g. X-rays)
• If you are diabetic, so you can receive instructions on eating and insulin dosage

You may need to remove your clothes and change into a gown for the examination.

You may also need to remove jewellery, spectacles, and any metal objects or clothing that might interfere with the X-ray images.

Do arrange to have someone drive you home after your procedure.

What can you expect from an IVC filter placement?

You can expect to go through the following:

Before the procedure

Numbing medicine will be injected into your skin over the vein before the catheter is inserted.

You may also be given intravenous medications to make you more comfortable and relaxed. This is known as conscious sedation.

During the procedure

You can expect to go through the following procedure:

• A plastic intravenous tube (catheter) will be inserted into a vein in either your groin or your neck.
• Once the catheter has been placed into the vein, it will be advanced through the blood vessels and into the IVC.
• X-ray contrast material (X-ray dye) will be injected through the catheter and X-ray pictures taken. You may be asked to hold your breath for several seconds as these pictures are taken.
• During the injection of X-ray contrast material, you may experience a warm feeling or a strange taste in your mouth. Both of these sensations are temporary and will dissipate after a while.
• A series of X-ray pictures will be obtained of the IVC.
• Once the catheter is placed into the IVC, the filter will be inserted through the catheter. Your doctor will position the filter with the help of the X-ray pictures during the placement procedure.
• Once the procedure has been completed, the catheter will be removed and pressure will be applied to the insertion site until the bleeding has stopped.

After the procedure

It is very important for you to lie flat in bed for up to 4 hours without moving your arm or leg to prevent bleeding.

Care and recovery after an IVC filter placement

You will remain in the recovery room until you are completely awake and ready to return home.

If your IVC filter was inserted through a vein in your neck, you should be able to resume your normal activities within 24 hours.

If your filter was inserted through a vein in your groin, you should:

• Avoid driving for 24 hours
• Lifting heavy objects and climbing stairs for 48 hours

You can shower 24 hours after your procedure.

Your doctor will provide any additional post-procedure instructions.

Your doctor may also recommend that you participate in cardiac rehabilitation to help you improve your health and recover after heart surgery.