Inferior Vena Cava (IVC) filter insertion or retrieval

Interventional Radiology and Fluoroscopy

What is an IVC filter?

An inferior vena cava filter is a medical device made of metal that is implanted by vascular surgeons or interventional radiologists into the inferior vena cava to prevent a life-threatening pulmonary embolism (PE).

The filter is designed to trap a blood clot and prevent its travel to the lung where it would form a pulmonary embolism. Their effectiveness and safety profile is well established, and they may be used when anticoagulant treatment is not sufficient.

What are benefits of having an IVC filter?

IVC filters can be lifesaving and recommended especially if patients are:

• Unable take blood-thinning medications (anticoagulants). This may be due to health issues, such as excessive bleeding, or a negative reaction
• Have many episodes of VTE, even while taking blood-thinning medications
• Have or have had a blood clot in a vein deep in your body – deep vein thrombosis (DVT)
• Have or have had a blood clot in your lung (pulmonary embolism) and are at high risk of recurrence

Are there any risks?

Serious risks and complications of having an IVC filter inserted are very rare. However, as with any procedure, some risks or complications may occur. For example:

• An allergic reaction to the contrast material
• Bleeding or infection at the skin puncture site
• Damage to your blood vessels
• Filter fracture, where the filter breaks into pieces
• Filter that moves to your heart or lungs
• A hole in the IVC created by the filter
• IVC thrombosis
• Kidney failure
• Pulmonary embolism

What do I need to do to prepare for the procedure?

You can come into hospital, have an IVC filter inserted and go home the same day.

• Please let us know if you are taking any medicines that thin the blood (for example Warfarin, Rivaroxaban, Dabigatran, Apixaban), as these may need to be withheld temporarily before the procedure. Call the Radiology Day Unit Sister for advice as soon as you get your appointment letter on 01642 854332.

You do not have to stop eating before the procedure, but you will be lying flat, so you should have a light breakfast. You may drink water up to the procedure.

What happens before the IVC filter insertion?

After you have arrived at the radiology day unit, you will be examined and assessed by a radiology nurse and given a hospital gown to wear.

You will be seen by a radiologist or radiographer (a health care professional who uses imaging machines to diagnose and treat illnesses) who will discuss the procedure with you. You will be given the opportunity to ask any questions you have.

Giving my consent (permission)

The staff caring for you will ask your permission to perform the procedure. If you decide to go ahead, you will be asked to sign a consent form that says you have agreed to the procedure and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or you need more time to think about it, please tell the staff caring for you.

How is the IVC filter inserted?

You will be taken into the x-ray room and asked to lie flat on the table. It may be necessary to shave hair (if needed) and then your skin will be cleaned with an antiseptic solution. They will use a local anaesthetic to numb the skin where they’ll insert a long, thin tube (catheter) into the veins.

Your surgeon uses pulses of an X-ray (fluoroscopy) to guide the catheter to your IVC. They may send X-ray dye (contrast material) through the catheter to more clearly see your IVC. The IVC filter will be placed in your IVC. The filter expands and attaches to your IVC’s walls.

Once the examination is finished, they will remove the equipment from the vein (apart from the filter). They will close and bandage the incision on your neck or groin.

Will I feel any pain?

As you are given a local anaesthetic, you should not feel any pain during the procedure. You may however feel some discomfort after the procedure when the local anaesthetic wears off. You may want to take paracetamol tablets for the pain. You may also have a little bruising.

What happens after the IVC filter insertion?

There are two types of IVC filters:

Permanent: You keep this type of filter long term. People who can’t take blood-thinning medications for health reasons usually get a permanent filter.

Optional or retrievable filters: You keep this type of filter temporarily. People with a temporary risk of blood clots or who can take blood-thinning medications at some point may get an optional filter.

You’ll keep a permanent vena cava filter indefinitely. But a retrievable filter may be removed when you:

• Are able to start taking blood thinners again
• Have a lower blood clot risk

Removing a retrievable IVC filter as soon as you no longer need it reduces your risk of complications such as:

• Filter fracture
• Injury to your IVC

They will remove the retrievable IVC filter through a vein in your neck similar to how it was inserted. The removal process usually takes about one hour.

Useful websites

Please visit: https://www.radiologyinfo.org/en/info/venacavafilter

Radiation dose and risk

X-rays use ionising radiation which can cause cell damage that may, after many years or decades, turn cancerous. The risk of this happening is very small compared to the normal lifetime risk of developing cancer which is 1 in 2.

We are also all exposed to background radiation every day. The risk of long-term effects is considered when the healthcare team decide whether someone needs an x-ray examination and radiation doses are kept as low as possible.

For this examination radiation dose levels are typically equivalent to around 1 to 2 years of background radiation. The associated risk is less than 1 in 1000 – Low.

Is there anything I should tell the staff?

For patients who have ovaries and are between the ages of 12 and 55, the x-ray department has a legal responsibility to ensure that this examination is performed within TEN DAYS of the first day of your menstrual period.

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

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