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Vena Cava Filter Placement and Retrieval
Brandt C. Wible, MD; Nathan Saucier, MD
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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
            • Not designed/approved for retrieval
              • Increasingly fewer insertions; nonpermanent filters preferred
          • 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

                            1. 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
                            2. 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
                            3. 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
                            4. Li X et al: Inferior vena cava filter - comprehensive overview of current indications, techniques, complications and retrieval rates. Vasa. 49(6):449-62, 2020
                            5. 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
                            6. 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
                            7. 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
                            8. Kearon C et al: Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 149(2):315-52, 2016
                            9. Abtahian F et al: Inferior vena cava filter usage, complications, and retrieval rate in cancer patients. Am J Med. 127(11):1111-7, 2014
                            10. Kalva SP et al: Long-term safety and effectiveness of the "OptEase" vena cava filter. Cardiovasc Intervent Radiol. 34(2):331-7, 2011
                            11. 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
                            12. 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
                            13. 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
                            14. Kalva SP et al: Suprarenal inferior vena cava filters: a 20-year single-center experience. J Vasc Interv Radiol. 19(7):1041-7, 2008
                            15. Stavropoulos SW et al: Embedded inferior vena cava filter removal: use of endobronchial forceps. J Vasc Interv Radiol. 19(9):1297-301, 2008
                            16. 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
                            17. 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
                            18. Ebaugh JL et al: Bedside vena cava filter placement guided with intravascular ultrasound. J Vasc Surg. 34(1):21-6, 2001
                            19. 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
                            20. 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
                                      • Not designed/approved for retrieval
                                        • Increasingly fewer insertions; nonpermanent filters preferred
                                    • 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

                                                      1. 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
                                                      2. 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
                                                      3. 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
                                                      4. Li X et al: Inferior vena cava filter - comprehensive overview of current indications, techniques, complications and retrieval rates. Vasa. 49(6):449-62, 2020
                                                      5. 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
                                                      6. 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
                                                      7. 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
                                                      8. Kearon C et al: Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 149(2):315-52, 2016
                                                      9. Abtahian F et al: Inferior vena cava filter usage, complications, and retrieval rate in cancer patients. Am J Med. 127(11):1111-7, 2014
                                                      10. Kalva SP et al: Long-term safety and effectiveness of the "OptEase" vena cava filter. Cardiovasc Intervent Radiol. 34(2):331-7, 2011
                                                      11. 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
                                                      12. 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
                                                      13. 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
                                                      14. Kalva SP et al: Suprarenal inferior vena cava filters: a 20-year single-center experience. J Vasc Interv Radiol. 19(7):1041-7, 2008
                                                      15. Stavropoulos SW et al: Embedded inferior vena cava filter removal: use of endobronchial forceps. J Vasc Interv Radiol. 19(9):1297-301, 2008
                                                      16. 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
                                                      17. 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
                                                      18. Ebaugh JL et al: Bedside vena cava filter placement guided with intravascular ultrasound. J Vasc Surg. 34(1):21-6, 2001
                                                      19. 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
                                                      20. Levy JM et al: Inferior vena cava filter placement. American College of Radiology. ACR Appropriateness Criteria. Radiology. 215 Suppl:981-97, 2000