PROCEDURE: Inferior venacavogram and IVC filter placement         

INDICATION:    

DATE:    

OPERATORS: 

MEDICATIONS: Versed     mg IV, Fentanyl     mcg IV

CONTRAST:     ml of    

FLUOROSCOPY TIME:     minutes

FILTER TYPE:    

ACCESS SITE:     vein with ultrasound

COMPLICATIONS: None

 

TECHNIQUE:

The risks, benefits, and alternatives to the procedure and sedation were explained to the    .  The specific risks of bleeding, infection, pulmonary embolism, filter mal deployment, and filter migration were detailed and accepted. Written informed consent was obtained. 

The patient was assessed for conscious sedation and found to be an adequate candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure. A time out was performed prior to procedure initiation.

The ____was prepped and draped in sterile fashion. 

The vascular structures were ultrasonographically evaluated.   Images were stored and transferred to PACS.  Under ultrasound guidance, the     vein was accessed with a micropuncture needle.  Vein patency and needle entry were documented.  A 0.018″ wire was placed and the needle exchanged for a 5 French dilator.

An Amplatz wire was advanced into the inferior vena cava, and the dilator exchanged for a 5 French marker pigtail catheter. Inferior venacavography was performed using nonionic contrast. This is a baseline study to define variant anatomy, caval size, location and number of renal veins, and to evaluate for ileocaval thrombus.

The Amplatz wire was replaced, and the pigtail exchanged for the     filter delivery system.

Under direct fluoroscopic guidance, the filter was positioned and deployed. A hand injection was performed to assess filter position.

The sheath was removed, and hemostasis achieved with compression.

No immediate complication occurred, and the patient was discharged from the angiography suite in satisfactory condition.

 

FINDINGS:

  1. There is no ileocaval thrombus.
  2. There are single renal veins bilaterally. The IVC is normal in caliber. There is no aberrant anatomy.
  3. The filter is appropriately positioned below the lowest renal vein.
  4. The ____vein is ultrasonographically patent and compresses. Needle entry was documented.  Images were stored to PACS.

 

IMPRESSION:

  1. No evidence for ileocaval thrombus.
  2. Uneventful image guided placement of an infrarenal  _____ IVC filter as described.

 

If the patient is a candidate for filter retrieval, this ideally should be scheduled within 1-3 months.