Nonpermanent filter: Designed for temporary caval interruption
Retrievable (optional) filters
Designed for removal after risk of PE resolved
Can remain permanently: < 50% of filters removed
Retrievability period: Variable (device specific)
Short-term contraindication for anticoagulation
Convertible (optional) filters
Permanent device that can be structurally altered to no longer function as filter
Conical filter arms retract to vessel wall away from lumen; frame remains attached permanently to vessel wall
If not converted, provides permanent protection
Temporary filters
Not designed for permanent placement
Must remove before filter/tether adheres to inferior vena cava (IVC)
Not available in USA
Anatomic filter placement locations/indications
Infrarenal IVC: Ideal/preferred VCF location
If normal IVC and renal veins: Place filter immediately below lowest renal vein level
If circumaortic left renal vein: Place filter below this level or suprarenal
Suprarenal IVC: Location indicated when infrarenal VCF placement problematic
Anatomic variants
Duplicated infrarenal IVC (1-2% incidence): Left IVC drains into normal left renal vein; joins right IVC; forms single normal suprarenal IVC
Left IVC (0.5% incidence): IVC enters left renal vein; courses right to form single normal suprarenal IVC
Low insertion of renal veins
Pregnancy
Thrombus in IVC/gonadal/renal veins
Pelvic mass compressing infrarenal IVC
Presurgical placement followed by surgery in which IVC manipulation may occur
Bilateral common iliac veins: Alternative location to suprarenal IVC filter placement
Anatomic variants
Duplicated IVC
Low insertion of renal veins
Megacava
Surgery in which IVC manipulation may occur
Superior vena cava (SVC): May be considered for upper extremity deep venous thrombosis (DVT)
Not routinely done
Literature suggests benefit in select subgroup of patients
Unique risks include
SVC thrombosis
Migration to heart (closer)
SVC perforation
Intravascular US (IVUS): Adjunct to fluoroscopy
Provides 360° intravascular field of view
Visualizes endothelium, venous confluences
Adjacent arterial/venous structures visualized
Provides image guidance if cannot use fluoroscopy
Bedside IVC filter placement
Contraindication to contrast or fluoroscopy
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Expected Outcomes
Selected References
Kesselman A et al: Current controversies in inferior vena cava filter placement: AJR expert panel narrative review. AJR Am J Roentgenol. 216(3):563-9, 2021
Liu Y et al: Effect of inferior vena cava filters on pulmonary embolism-related mortality and major complications: a systematic review and meta-analysis of randomized controlled trials. J Vasc Surg Venous Lymphat Disord. 9(3):792-800.e2, 2021
Kaufman JA et al: Society of Interventional Radiology clinical practice guideline for inferior vena cava filters in the treatment of patients with venous thromboembolic disease: developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine. J Vasc Interv Radiol. 31(10):1529-44, 2020
Li X et al: Inferior vena cava filter - comprehensive overview of current indications, techniques, complications and retrieval rates. Vasa. 49(6):449-62, 2020
Expert Panel on Interventional Radiology et al: ACR Appropriateness Criteria® radiologic management of venous thromboembolism-inferior vena cava filters. J Am Coll Radiol. 16(5S):S214-26, 2019
Tavri S et al: Endobronchial forceps-assisted complex retrieval of inferior vena cava filters. J Vasc Surg Venous Lymphat Disord. 7(3):413-9, 2019
Bikdeli B et al: Inferior vena cava filters to prevent pulmonary embolism: systematic review and meta-analysis. J Am Coll Cardiol. 70(13):1587-97, 2017
Kearon C et al: Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 149(2):315-52, 2016
Abtahian F et al: Inferior vena cava filter usage, complications, and retrieval rate in cancer patients. Am J Med. 127(11):1111-7, 2014
Kalva SP et al: Long-term safety and effectiveness of the "OptEase" vena cava filter. Cardiovasc Intervent Radiol. 34(2):331-7, 2011
Oh JC et al: Removal of retrievable inferior vena cava filters with computed tomography findings indicating tenting or penetration of the inferior vena cava wall. J Vasc Interv Radiol. 22(1):70-4, 2011
Van Ha TG et al: Use of retrievable filters in alternative common iliac vein location in high-risk surgical patients. J Vasc Interv Radiol. 22(3):325-9, 2011
Nicholson W et al: Prevalence of fracture and fragment embolization of Bard retrievable vena cava filters and clinical implications including cardiac perforation and tamponade. Arch Intern Med. 170(20):1827-31, 2010
Kalva SP et al: Suprarenal inferior vena cava filters: a 20-year single-center experience. J Vasc Interv Radiol. 19(7):1041-7, 2008
Stavropoulos SW et al: Embedded inferior vena cava filter removal: use of endobronchial forceps. J Vasc Interv Radiol. 19(9):1297-301, 2008
Kaufman JA et al: Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference. J Vasc Interv Radiol. 17(3):449-59, 2006
PREPIC Study Group: Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study. Circulation. 112(3):416-22, 2005
Ebaugh JL et al: Bedside vena cava filter placement guided with intravascular ultrasound. J Vasc Surg. 34(1):21-6, 2001
Grassi CJ et al: Quality improvement guidelines for percutaneous permanent inferior vena cava filter placement for the prevention of pulmonary embolism. SCVIR Standards of Practice Committee. J Vasc Interv Radiol. 12(2):137-41, 2001
Levy JM et al: Inferior vena cava filter placement. American College of Radiology. ACR Appropriateness Criteria. Radiology. 215 Suppl:981-97, 2000
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
TERMINOLOGY
Abbreviations
Vena cava filter (VCF)
Definitions
VCF: Endovascular medical device implanted percutaneously in vena cava
Designed to mechanically trap venous emboli
Mechanical prophylaxis against pulmonary embolus (PE)
Permanent filter: Designed for permanent caval interruption
Indicated for long-term contraindication to anticoagulation
Nonpermanent filter: Designed for temporary caval interruption
Retrievable (optional) filters
Designed for removal after risk of PE resolved
Can remain permanently: < 50% of filters removed
Retrievability period: Variable (device specific)
Short-term contraindication for anticoagulation
Convertible (optional) filters
Permanent device that can be structurally altered to no longer function as filter
Conical filter arms retract to vessel wall away from lumen; frame remains attached permanently to vessel wall
If not converted, provides permanent protection
Temporary filters
Not designed for permanent placement
Must remove before filter/tether adheres to inferior vena cava (IVC)
Not available in USA
Anatomic filter placement locations/indications
Infrarenal IVC: Ideal/preferred VCF location
If normal IVC and renal veins: Place filter immediately below lowest renal vein level
If circumaortic left renal vein: Place filter below this level or suprarenal
Suprarenal IVC: Location indicated when infrarenal VCF placement problematic
Anatomic variants
Duplicated infrarenal IVC (1-2% incidence): Left IVC drains into normal left renal vein; joins right IVC; forms single normal suprarenal IVC
Left IVC (0.5% incidence): IVC enters left renal vein; courses right to form single normal suprarenal IVC
Low insertion of renal veins
Pregnancy
Thrombus in IVC/gonadal/renal veins
Pelvic mass compressing infrarenal IVC
Presurgical placement followed by surgery in which IVC manipulation may occur
Bilateral common iliac veins: Alternative location to suprarenal IVC filter placement
Anatomic variants
Duplicated IVC
Low insertion of renal veins
Megacava
Surgery in which IVC manipulation may occur
Superior vena cava (SVC): May be considered for upper extremity deep venous thrombosis (DVT)
Not routinely done
Literature suggests benefit in select subgroup of patients
Unique risks include
SVC thrombosis
Migration to heart (closer)
SVC perforation
Intravascular US (IVUS): Adjunct to fluoroscopy
Provides 360° intravascular field of view
Visualizes endothelium, venous confluences
Adjacent arterial/venous structures visualized
Provides image guidance if cannot use fluoroscopy
Bedside IVC filter placement
Contraindication to contrast or fluoroscopy
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Expected Outcomes
Selected References
Kesselman A et al: Current controversies in inferior vena cava filter placement: AJR expert panel narrative review. AJR Am J Roentgenol. 216(3):563-9, 2021
Liu Y et al: Effect of inferior vena cava filters on pulmonary embolism-related mortality and major complications: a systematic review and meta-analysis of randomized controlled trials. J Vasc Surg Venous Lymphat Disord. 9(3):792-800.e2, 2021
Kaufman JA et al: Society of Interventional Radiology clinical practice guideline for inferior vena cava filters in the treatment of patients with venous thromboembolic disease: developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine. J Vasc Interv Radiol. 31(10):1529-44, 2020
Li X et al: Inferior vena cava filter - comprehensive overview of current indications, techniques, complications and retrieval rates. Vasa. 49(6):449-62, 2020
Expert Panel on Interventional Radiology et al: ACR Appropriateness Criteria® radiologic management of venous thromboembolism-inferior vena cava filters. J Am Coll Radiol. 16(5S):S214-26, 2019
Tavri S et al: Endobronchial forceps-assisted complex retrieval of inferior vena cava filters. J Vasc Surg Venous Lymphat Disord. 7(3):413-9, 2019
Bikdeli B et al: Inferior vena cava filters to prevent pulmonary embolism: systematic review and meta-analysis. J Am Coll Cardiol. 70(13):1587-97, 2017
Kearon C et al: Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 149(2):315-52, 2016
Abtahian F et al: Inferior vena cava filter usage, complications, and retrieval rate in cancer patients. Am J Med. 127(11):1111-7, 2014
Kalva SP et al: Long-term safety and effectiveness of the "OptEase" vena cava filter. Cardiovasc Intervent Radiol. 34(2):331-7, 2011
Oh JC et al: Removal of retrievable inferior vena cava filters with computed tomography findings indicating tenting or penetration of the inferior vena cava wall. J Vasc Interv Radiol. 22(1):70-4, 2011
Van Ha TG et al: Use of retrievable filters in alternative common iliac vein location in high-risk surgical patients. J Vasc Interv Radiol. 22(3):325-9, 2011
Nicholson W et al: Prevalence of fracture and fragment embolization of Bard retrievable vena cava filters and clinical implications including cardiac perforation and tamponade. Arch Intern Med. 170(20):1827-31, 2010
Kalva SP et al: Suprarenal inferior vena cava filters: a 20-year single-center experience. J Vasc Interv Radiol. 19(7):1041-7, 2008
Stavropoulos SW et al: Embedded inferior vena cava filter removal: use of endobronchial forceps. J Vasc Interv Radiol. 19(9):1297-301, 2008
Kaufman JA et al: Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference. J Vasc Interv Radiol. 17(3):449-59, 2006
PREPIC Study Group: Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study. Circulation. 112(3):416-22, 2005
Ebaugh JL et al: Bedside vena cava filter placement guided with intravascular ultrasound. J Vasc Surg. 34(1):21-6, 2001
Grassi CJ et al: Quality improvement guidelines for percutaneous permanent inferior vena cava filter placement for the prevention of pulmonary embolism. SCVIR Standards of Practice Committee. J Vasc Interv Radiol. 12(2):137-41, 2001
Levy JM et al: Inferior vena cava filter placement. American College of Radiology. ACR Appropriateness Criteria. Radiology. 215 Suppl:981-97, 2000
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