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IVC Filter Placement Steps

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Ep 204 Filter Indications and Filter Tracking: Up Your Game with Dr. Stephen Wang

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Pre-Procedure Prep

IVC Filter Indications

IVC filter guidelines vary

Society of Interventional Radiology (SIR) Guidelines:
Therapeutic (documented thromboembolic disease)
• Contraindication to anticoagulation
• Complications to anticoagulation
• Failure of anticoagulation
• Recurrent PE despite adequate therapy
• Inability to achieve/maintain adequate anticoagulation
• Propagation/progression of DVT during therapeutic anticoagulation
• Massive PE with residual DVT in patient at risk for further PE
• Free-floating iliofemoral or IVC thrombus
• Severe cardiopulmonary disease and DVT
Prophylactic placement
• Severe trauma without DVT
• Closed head injury, spinal cord injury, multiple long bone fractures
• High risk patients (immobilized or ICU)

American College of Chest Physicians (ACCP)
• Contraindication to anticoagulation
• Massive PE with DVT

Relative Contraindications

• Uncorrectable severe coagulopathy
• Bacteremia or untreated infection

Pre-Procedural Evaluation

• H&P
• GFR - if renal insufficiency a concern, can use CO2 or IVUS
• Review prior imaging: is a filter already present, cava size, IVC duplication/atresia, position of renal veins

IVC Filter Placement Podcasts

Listen to leading physicians discuss ivc filter placement on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Episode #204

Filter Indications and Filter Tracking: Up Your Game

We talk with interventional radiologist Dr. Stephen Wang about building an IVC filter retrieval program, the current guidelines on filter placement, and how to minimize the complications of filters.

Episode #35

Over-the-Wire Technique for IVC Filter Placement

Dr. David Mobley of Columbia University VIR describes his over-the-wire technique to prevent tilting in IVC filter placement. Special thanks to our sponsor Argon Medical.

Episode #11

Hashtag filterOUT

On Episode 11 of the BackTable Podcast Robert Ryu and AJ Gunn discuss building a filter retrieval practice, equipment preferences, and challenging cases.

IVC Filter Procedure Steps

Antibiotic

No routine antibiotic prophylaxis recommended

Venous Access

• Jugular vs. Femoral
• Primarily operator preference

Choose Filter Type

Many options, both retrievable and permanent
Over the wire, place sheath. Size of sheath depends on filter

Perform Cavogram (15 mL/s for 30 mL)

• Cava size, variant anatomy, IVC thrombus
• Position and number of renal veins

Filter Deployment

• Will vary based on filter specifics
• Patient anatomy and extent of clot
• Unsheath filter without advancing or retracting the filter

Post Filter Cavogram

• Document position/tilt
• If jugular approach, avoid contact with filter which can alter positioning
Remove sheath

IVC Filter Placement Articles

Read our exclusive BackTable VI Articles for quick insights on ivc filter placement, provided by physicians for physicians.

Tips and Techniques For Over-The-Wire IVC Filter Placement

The OTW technique for IVC filter placement was designed to improve the deployment and positioning of IVC filters while minimizing procedure complications. Dr. Mobley discusses filter stabilization techniques, periprocedural insight, and preferred vascular access sites for OTW IVC filter deployment.

Argon Option ELITE IVC Filter Placement Technique

IVC filters are used prophylactically in patients with contraindications to anticoagulants in order to prevent pulmonary embolism. Dr. David Mobley discusses over-the-wire (OTW) IVC filter placement techniques using the Argon Option ELITE filter, and why this technique helps to minimize tilting complications.

Post-Procedure

IVC Filter Placement Complications

• Access site bleeding or thrombosis
• IVC thrombosis
• Filter issues: perforation, migration, embolization, fracture
• Infection
• Misdeployment
• Bleeding
• Air embolism

IVC Filter Placement Post-Operative Care

• Important to have system in place for follow up and potential filter retrieval
• 1 hour recovery

IVC Filter Placement Demos

Watch video walkthroughs of ivc filter placement on the BackTable VI expanded content network.

Inferior Vena Cava (IVC) Filter Placement

References

[1] DeYoung E, Minocha J. Inferior Vena Cava Filters: Guidelines, Best Practice, and Expanding Indications. Semin Intervent Radiol. 2016;33(2):65‐70. doi:10.1055/s-0036-1581088
[2] Mismetti P, Laporte S, Pellerin O, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA. 2015;313(16):1627‐1635. doi:10.1001/jama.2015.3780
[3] Caplin DM, Nikolic B, Kalva SP, et al. Quality improvement guidelines for the performance of inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol. 2011;22(11):1499‐1506. doi:10.1016/j.jvir.2011.07.012
[4] Funaki B. Inferior vena cava filter insertion. Semin Intervent Radiol. 2006;23(4):357‐360. doi:10.1055/s-2006-957026
[5] Decousus H, Leizorovicz A, Parent F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. 1998;338(7):409‐415. doi:10.1056/NEJM199802123380701

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