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Inferior vena cava filters avoid pulmonary embolism (PE) by being inserted into the inferior vena cava (IVC). IVC filter is a device that filters out small clots that break away from larger clots, keeping them from passing into your heart and lungs. It is a Blood clot filter.

Table of Contents

What is a deep vein thrombosis or DVT?

A deep vein thrombosis occurs when blood clots form in deep veins in the body.

What is venous thromboembolism (VTE)?

Clots of deep veins (DVT) often break off, traveling up the affected vein toward the heart and lungs, causing Venous thromboembolism. Venous thromboembolism (VTE) can be severe and even life-threatening.

What is pulmonary embolism (PE)?

Venous thromboembolism (VTE) to the lungs is knowns as pulmonary embolism, which can be fatal if not treated immediately.

Treatment of DVT?

Blood-thinning medications called anticoagulants are standard therapy for DVT.

Few blood-thinning medications are:

* Rivaroxaban

* Dabigatran

* Apixaban

* Edoxaban

* Heparin

* Fondaparinux

The doctor may suggest an IVC filter for DVT treatment when there are contraindications or complications with anticoagulants.

How is Pulmonary embolism (PE) prevented?

Before hip replacement or other major orthopedic surgeries, doctors use Anticoagulants as preventive measures for DVT and pulmonary embolism. Anticoagulants that are used for DVT also prevent Pulmonary embolism. IVC filters (inferior vena cava filter) are inserted when there are contraindications for Anticoagulants.

What are IVC filters?

The inferior vena cava (IVC) is a long blood vessel in your body that returns blood from your legs and belly to your heart. An inferior vena cava filter or IVC filter (blood clot filters) is placed inside IVC to treat some patients with deep vein thrombosis (DVT). IVC filter (DVT filter) is intended to prevent clot migration to the heart and lungs. If you’ve been diagnosed with DVT and are prescribed an IVC filter (blood clot filters) as part of your treatment plan, make sure you know how this device can help you. Here’s what you need to know about the IVC filter (inferior vena cava filter)

The IVC Filter surgery (DVT filter surgery): A Vital Treatment for Deep Vein thrombosis in few patients

A deep vein thrombosis, or DVT, can result in life-threatening pulmonary embolism (PE). We don’t indicate the IVC Filter for all cases of DVT. Blood-thinning medications called anticoagulants to suffice for most patients. Fortunately, doctors can prevent this complication with an IVC filter (DVT filter), which catches migrating blood clots and prevents them from reaching your lungs.

How do you know if you need an IVC Blood clot filter?

If you are diagnosed with DVT, your doctor may recommend an IVC filter (inferior vena cava filter). Doctors typically place a filter on patients who have high-risk factors for pulmonary embolism (PE), who do not respond to anticoagulant medication, or who are not a candidate for anticoagulant medicines.

Anyone at risk of developing Pulmonary embolism with contraindications for anticoagulant medication may be a candidate. High-risk candidates for pulmonary embolism are patients with DVT.

Indications for IVC filter surgery:

Absolute contraindication to anticoagulation
Anticoagulation complications (severe bleeding)
Anticoagulation failure (developing DVT or PE despite taking anticoagulants)

Absolute contraindication to anticoagulation

Bleeding in the brain
severe active bleeding
Recent brain, eye, or spinal cord surgery
Extreme high blood pressure (malignant hypertension)

Relative contraindications to anticoagulation

Recent major surgery
Recent brain stroke
Severe thrombocytopenia or low platelet count
Hemophilia

Therapeutic Blood clot filters are used in established cases of DVT.

Prophylactic Blood clot filters are used in individuals at high risk of venous thromboembolism, especially after trauma. These include people recovering from injuries or surgery that causes immobility, individuals taking long trips on airplanes or traveling to areas with high altitudes, and people with heart failure or respiratory diseases like emphysema. Anticoagulants are commonly prescribed for such indications. When Anticoagulants are unsuitable, IVC filters are used.

Tests required for IVC filter surgery

Prothrombin time (PT)
Partial thromboplastin time (PTT)
International normalized ratio (INR)
Renal function tests, such as blood urea nitrogen and creatinine
HIV, HBsAg, HCV serology
Complete blood picture
Ultrasound abdomen
Ultrasound for leg veins

computed tomography (CT) or magnetic resonance (MR) study of the abdomen is rarely needed

Equipment for IVC filter surgery

* Inferior vena cava (IVC) filter

* Catheter

* C-arm or fluoroscopy (x-ray)

* Ultrasound machine

* Local anesthetic drugs

* Intravenous line

* Drugs to calm you

* Contrast dye

Personnel for IVC filter surgery

* Interventional cardiologist

* Nurse

* Technician

How are they implanted?

Fluoroscopy (cath-lab or C-arm) is used to guide the position of IVC filters. The filter is implanted through a vein in your groin or neck. Allin all, it should take less than an hour to complete. The best part? You don’t even need general anesthesia to get it done. Antibiotic prophylaxis is not always advised with IVC filter surgery.

Where the procedure is done?

IVC filters (inferior vena cava filters) can be placed at:

1. 1. Bedside: fluoroscopy (x-ray), ultrasound, or both.
  2. Cath-lab
  3. C-arm

Bedside

IVC filters can be put at the bedside using fluoroscopy (x-ray). It avoids patient transport to the interventional suite, which can be problematic in severely ill patients. This necessitates using an ICU bed that can handle an angiographic C-arm. Ultrasound can also be used to put the device at the bedside.

Access

An internal jugular (vein in the neck) or femoral vein (vein in the groin) can be used (Some can be inserted into a peripheral vein in the upper extremities (usually the brachial or basilic vein).

So common access sites are:

1. 1. 1. 1. Neck
      2. Groin
      3. Arm

ivc filter access sites — IVC filter access sites

Known venous stenosis or clot, bleeding risk, body mass index, possibly the presence of any venous anomalies (if known), and, to some extent, the patient’s preference or condition are all factors considered when choosing an access site.

Once the vein is punctured, your doctor passes a wire over which a sheath is inserted. Then your doctor takes an injection to know the anatomy of IVC. After deciding the ideal site, he places an IVC filter, usually below veins draining your kidney. Once the device is released, the sheath is removed.

Do I need to take medication after my surgery?

The IVC filter (inferior vena cava filter) is meant for candidates with contraindications or complications with anticoagulants. So There is no need to use any blood thinners after the IVC filter. Once the IVC filter is removed, your doctor may advise blood thinners.

IVC filter (inferior vena cava filter) cost in India?

Cost depends on the type of the hospital, type of filter, and complexity of the procedure. It is done free of cost in government hospitals. We charge around one to 1.5 lakhs for the IVC filter procedure in Hyderabad.

How long will my device last in my body?

The filters are designed to remain in place indefinitely or temporarily, but mostly a doctor may recommend removing one.

When should I consider the removal of my filter?

The decision to remove your IVC filter should be based on several factors, including whether or not you are still at risk of a blood clot, your symptoms, and complications with having a foreign object in your body.

Types of IVC filters (inferior vena cava filters)

Permanent and retrievable vena cava filters are the two types of available vena cava filters. Retrievable IVC filters are removed after protection is no longer required.

Nonretrievable filters or permanent IVC filters:

There are several non-retrievable IVC filters. These are Permanent filters intended to stay in the body forever.

* Bird’s Nest (Cook Medical, 1982)

* Vena Tech LGM filter (B. Braun, 1989)

* Vena Tech LP (B. Braun, 2001)

* Titanium Greenfield filter (Boston Scientific, 1989)

* TRAPEASE filter (Cordis, 2000)

* Simon Nitinol filter (C. R. Bard, 1990) is a bi-level filtration device designed for permanent implantation that is no longer commercially available.

Indications for Permanent Filters

1. 1. 1. 1. Limited Life Expectancy
        
        Long-term Contraindication to Anti-Coagulation
        
        Failed Retrieval
        
        VTE (Venous Thromboembolism) on Anticoagulation
        
        Patient Preference

Retrievable filters

There are also a variety of retrievable filters. Retrievable IVC filters should be removed as soon as it is no longer needed to prevent pulmonary embolism (PE).

* C.R. Bard IVC Filters

o G2 Express and G2X: 2008

o Eclipse: 2010

o Meridian: 2011

o Denali: 2013

* Cook Medical IVC Filters

* Gunther Tulip (GT)(Cook Medical, Bloomington, Indiana)

o Celect:

* Rex Medical IVC Filters

o Option: 2009

o Option Elite: 2013

* Other IVC Filters

retrievable OptEase inferior vena cava filter (IVCF) (Cordis Corporation, Miami Lakes, FL)

o ALN IVC Filter: Manufactured by ALN, 2012.

Cook Celect(r) Platinum Vena Cava Filter (Cook Medical, Bloomington, Indiana), Option(tm)ELITE Inferior Vena Cava Filter System can be used For temporary or permanent placement.

If you are going to have a hip replacement, you are at increased risk of developing DVT and PE. You need blood thinners to prevent them. If you have contraindications for them, your doctor advises IVC filters. Once the surgery is over, he will remove it.

When can I face difficulties during IVC filter placement?

Venous abnormalities: Venous abnormalities such as the constriction of the vein or the vena cava may make it difficult to place the filter successfully. Such Narrowing might be caused by stricture or thrombus, or it can be caused by extrinsic compression.

Congenital malformations: Congenital malformations are other conditions that can affect the placement of vena cava filters. A circumaortic left renal vein and a duplicated and left-sided vena cava are more prevalent anomalies.

Aftercare – IVC filter surgery

The head of the bed should be elevated to 45 degrees or more for two hours for patients with implantation through the neck.

If a groin approach is used, the patient should be kept in bed for four hours with the access leg straight. If the patient is taking anticoagulants at the procedure, the bed rest period may need to be extended.

Complications of IVC filter surgery

Bruising or infection at the puncture site
Adverse reactions to contrast or other drugs used during the procedure
Filter malposition
Risks associated with the access site, such as venous clot or arteriovenous fistula
Long-term consequences include filter erosion/migration or embolization and chronic clot/recurrent thromboembolism.

Complication rates may be higher with retrievable compared with non-retrievable filters.

Filter erosion/migration or embolization:

The filter can get displaced over time in a few unlucky patients.

Acute and recurrent deep vein thrombosis:

Although filter insertion may protect the pulmonary vascular bed, it slightly increases DVT risk.

IVC clot:

New local thrombus formation due to thrombogenicity of the device or trapped embolus has been reported in 3 to 30% of patients following IVC filter placement. It can cause edema in the lower extremities and ulcers in the foot.

Risk of lung embolism:

Small thrombi can still pass through patent filters or collaterals around clogged filters, causing a repeated pulmonary embolism (clots in the lung). Direct thrombus extension can also occur through the filter, causing a recurrent pulmonary embolism (PE).

Mortality:

Mortality is relatively low with the IVC filter (inferior vena cava filter) procedure.

Retrieval/ removal of IVC filter (inferior vena cava filter)

Manufacturer recommendations for filter retrieval timing vary. Retrieval success declines as placement time increases. Retrievable filters are removed once the indication for the filter is over. Doctors recommend removal within 29 to 54 days of insertion. There are cases where the filter has been removed after years of indwelling time.

Patients may be in danger if IVC filters (inferior vena cava filters) are not retrieved because they are linked to problems such as vena cava wall perforation, clot or stenosis, and filter breakage or migration.

The longer the filter is in place, the more likely it will cause issues during retrieval. Fracture and IVC injury are two of the most commonly reported problems during filter retrieval (e.g., dissection). As a result, removing the IVC filter (inferior vena cava filter) as soon as it is no longer required is strongly advised.

IVC filter removal cost

The cost of the IVC filter removal varies depending on the hospital and the complexity of the procedure. Retrievable filters are easy to remove when done shortly after the procedure. As indwelling time increases, both cost and complications increase.

Reason for failed initial retrieval

Thrombus in filter

Endothelialized

Re-inserted above filling defect

Filter tilted/ Unable to snare

Access route thrombosed

SVC filters:

Indication for placement of filters in the superior vena cava (SVC) is for patients with deep vein thrombosis of the arm and contraindications to anticoagulation.