What is an inferior vena cava (IVC) filter?
The primary treatment for blood clots in the legs (deep vein thrombosis or DVT) is blood thinners (anticoagulants). However, some patients may not be able to receive blood thinners, either temporarily or permanently. In those patients, an inferior vena cava (IVC) filter is the next best option.
An IVC filter is a small metal device implanted in the inferior vena cava, the large vein that returns blood back to the heart from the lower body. It is placed in the vein to prevent dangerous blood clots from traveling to the lungs.
There are two categories of IVC filters:
- Optionally retrievable
The type of filter implanted depends on a variety of factors such as the patient's ability to take blood thinners and the length of time the risk for blood clots is present.
How does the IVC filter work?
Inside the vein, the IVC filter works by allowing blood to flow around a trapped blood clot until the body's natural blood thinner (anticoagulants) break it down. Without the IVC filter in place, a blood clot traveling to the lung could cause a blockage of the pulmonary artery. This is known as a pulmonary embolism (PE), a life-threatening condition.
Why should a filter be removed?
IVC filters may need to be removed because they can increase risks of new blood clot formation in the legs and abdomen. Certain filter types have been found to fracture and/or cause symptoms from the filter legs penetrating the wall of the inferior vena cava. Removal is also recommended when the filter is no longer needed, according to the United States Food and Drug Administration
When should an IVC filter be removed?
It is recommended that a removable filter be removed when the risk of a blood clot traveling to the lungs has passed, or if a patient can take blood thinners.
How is an IVC filter removed?
The following procedures are used to remove a previously implanted IVC filter. Procedures are performed on an outpatient basis under moderate sedation or limited use of general anesthesia, with brief post-procedure observation and return to normal activities the next day.
Standard IVC Removal Process
A special device called a snare is inserted into the jugular vein, the large vein in the neck. Most removable IVC filters have a small hook at one end. Using fluoroscopy (X-ray guidance) the snare is used to latch onto the small hook, and once attached, to withdraw the filter. The procedure is usually done with moderate sedation and local anesthesia (numbing medicine), though it can also be done under general anesthesia.
If this standard removal procedure is unsuccessful, an advanced complex filter removal procedure developed by Penn Interventional Radiology, called the "jaws of life" technique, can be used.
Forceps Retrieval of IVC Filters (Complex IVC Filter Removal)
Penn Interventional Radiologists invented the technique of forceps retrieval of IVC filters, also known as the “jaws of life” technique. Forceps retrieval is the preferred technique for complex IVC filter removal worldwide.
In this procedure, long forceps (instead of a snare) are used to gently tease the filter from the wall of the vein and remove it. This technique is very effective even when other complex filter removal techniques have been attempted and failed.
How do I know if I am a candidate for IVC filter removal?
If the filter in place is one that is retrievable, you may be a candidate for removal. The forceps technique currently offers nearly 100% success in removing all types of retrievable filters. If you are not sure about the filter type, an office consultation with our Penn IR specialists can help to determine what treatment may be right for you.
What are the risks associated with IVC filter removal?
The risks for complex filter removal are slightly higher than those for routine removal. However, based on over 10 years of experience and performance of over 500 complex removal procedures here at Penn IR, the risks are still very low.
Are routine medications safe to take prior to IVC filter removal?
Most routine medications are safe to continue taking, but there are a few exceptions. Blood thinners may or may not be suspended during the procedure depending upon the expected complexity of the removal. Please inform your physician of all routine medications you are taking to determine whether they are safe to continue. During your office visit, you will be instructed regarding which medications to continue taking.
- Clinical Briefing, June 2017: Complex Retrieval of Embedded Inferior Vena Cava Filters
- Trerotola SO, Stavropoulos SW. Management of fractured inferior vena cava filters: Outcomes by fragment location. Radiology. 2017 Sep;284(3):887-896. doi: 10.1148/radiol.2017162005. Epub 2017 Apr 19.
- Stavropoulos SW, Ge BH, Mondschein JI, Shlansky-Goldberg RD, Sudheendra D, Trerotola SO. Retrieval of tip-embedded inferior vena cava filters by using the endobronchial forceps technique: Experience at a single institution. Radiology. 2015 Jun;275(3):900-7. doi: 10.1148/radiol.14141420. Epub 2015 Jan 12.
- Stavropoulos SW, Solomon JA, Trerotola SO. Wall-embedded recovery inferior vena cava filters: Imaging features and technique for removal. J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):379-82.