PROCEDURE: Inferior venacavogram and IVC filter placement        Â
INDICATION:Â Â Â Â
DATE:Â Â Â Â
OPERATORS:Â
MEDICATIONS: Versed   mg IV, Fentanyl   mcg IV
CONTRAST:   ml of   Â
FLUOROSCOPY TIME: Â Â minutes
FILTER TYPE:Â Â Â Â
ACCESS SITE: Â Â 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.Â
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.Â
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:
- There is no ileocaval thrombus.
- There are single renal veins bilaterally. The IVC is normal in caliber. There is no aberrant anatomy.
- The filter is appropriately positioned below the lowest renal vein.
- The ____vein is ultrasonographically patent and compresses. Needle entry was documented. Images were stored to PACS.
IMPRESSION:
- No evidence for ileocaval thrombus.
- 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.
Frequently Asked Questions
What is an IVC filter and why is it used?
An Inferior Vena Cava (IVC) filter is a small device placed in the inferior vena cava, the large vein that carries blood from the lower body to the heart. It is used to prevent blood clots from traveling to the lungs, known as pulmonary embolisms, especially in patients who cannot take blood thinners. The filter catches clots before they can cause harm.
How is an IVC filter placed?
The placement of an IVC filter involves inserting it through a vein, often in the neck or groin, using a needle and guide wire under fluoroscopic and ultrasound guidance. The filter is then positioned in the inferior vena cava. The procedure is done under conscious sedation, where the patient is awake but relaxed and pain-free.
What are the risks associated with IVC filter placement?
IVC filter placement carries risks such as bleeding, infection, misplacement of the filter, and migration of the filter to other parts of the body. These risks are generally low, especially with experienced practitioners, and patients are monitored closely throughout the procedure to minimize complications.
How long should an IVC filter stay in place?
The duration an IVC filter should remain in place depends on the patient's condition. If possible, it's ideal to retrieve the filter within 1 to 3 months after placement to minimize long-term risks. However, some filters can be left in place permanently if removal is not possible or necessary.
What is the recovery process like after IVC filter placement?
After the procedure, patients are typically monitored for a short period to ensure no immediate complications. Most can go home the same day. Recovery involves following care instructions for the insertion site, watching for signs of infection, and attending follow-up appointments. Normal activities can often be resumed quickly, but strenuous activities may need to be avoided initially.
Can an IVC filter be removed?
Yes, many IVC filters are designed to be temporary and can be removed. The removal procedure is similar to the placement and involves retrieving the filter through a vein. The timing of removal is important and ideally done within 1 to 3 months if the risk of clotting has decreased and the patient's condition allows.
What should patients expect during the IVC filter placement procedure?
During the IVC filter placement, patients receive conscious sedation, meaning they are awake but comfortable and pain-free. A nurse continuously monitors vital signs. The procedure involves inserting a filter through a vein using imaging guidance to ensure correct placement. It usually takes about an hour, and patients can often leave the hospital the same day.