PROCEDURE: Inferior venacavagram and IVC filter removal with followup cavogram
INDICATION:
DATE:
OPERATORS:
MEDICATIONS:
CONTRAST: ml of nonionic contrast
FLUOROSCOPY TIME:
FILTER TYPE:
ACCESS SITE: with ultrasound guidance
COMPLICATIONS: None
TECHNIQUE:
The risks, benefits, and alternatives to the procedure and sedation were explained to the . The specific risks of vascular damage and pulmonary embolus 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.
The ____was prepped and draped in sterile fashion. Under ultrasound guidance, the vein was accessed with a micropuncture needle. Vein patency and needle entry were documented. Images were stored and transferred to PACS. A 0.018″ wire was placed and the needle exchanged for a 5 French dilator. A sheath was placed at the access site.
A multisidehole catheter was advanced over the wire and positioned below the IVC filter under fluoroscopy. Inferior venacavography was then performed to assess the filter for captured thrombus.
The catheter was exchanged for the filter removal system. This was positioned just above the filter tip. The ____ was advanced over the wire and deployed just above the central tip of the IVC filter. The filter was engaged with confirmation in multiple projections. The filter was then pulled through the retrieval sheath under fluoroscopic guidance.
A pigtail catheter was advanced over the wire and positioned in the infrarenal IVC. Inferior venacavography was performed to assess IVC integrity after filter retrieval. The images were reviewed.
The catheter, wire and right jugular sheath were 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 significant thrombus within the infrarenal IVC filter.
- The filter was removed without incident.
- Post removal cavography shows no contrast extravasation or leak. The IVC is intact.
IMPRESSION:
- No evidence for significant captured thrombus within the infrarenal IVC filter.
- Uneventful image guided retrieval of an infrarenal IVC filter as described.
Frequently Asked Questions
What is an IVC filter and why is it used?
An IVC (Inferior Vena Cava) filter is a small, metal 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 pulmonary embolisms by capturing blood clots that may travel from the legs or pelvis towards the lungs. IVC filters are often used in patients who cannot take blood thinners or have recurrent clotting issues despite medication.
How is an IVC filter removed?
IVC filter removal involves a minimally invasive procedure where a catheter-based system is used. Under fluoroscopic guidance, a retrieval sheath is advanced to the filter location. The filter is then engaged and retracted into the sheath for removal. This is typically done through a small incision in a neck or groin vein. The procedure is monitored to ensure no complications occur, such as damage to the vein.
What are the risks associated with IVC filter removal?
The risks of IVC filter removal are generally low but can include vascular damage, bleeding, or complications related to anesthesia. Rarely, parts of the filter may break off during retrieval, which could require additional intervention. The procedure is usually safe, especially when performed by experienced medical professionals using image guidance techniques.
How long does it take to recover from an IVC filter removal?
Recovery from IVC filter removal is typically quick. Most patients can return to normal activities within a day or two. The procedure is minimally invasive, so it causes less trauma compared to surgical methods. Patients are usually monitored for a short period after the procedure to ensure there are no immediate complications before being discharged.
Why might an IVC filter need to be retrieved?
An IVC filter may need to be retrieved because it was intended as a temporary solution until the risk of blood clots is reduced or eliminated. Over time, filters can cause complications, such as migration, fracture, or penetration into the vein wall. Retrieval is advised to prevent these issues and to ensure the patient’s long-term health and safety.
What is the role of fluoroscopy in IVC filter retrieval?
Fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray movie. In IVC filter retrieval, it is used to guide the placement and movement of the retrieval tools within the body, ensuring precise and safe extraction of the filter. It allows the physician to see the exact location of the filter and surrounding structures during the procedure.
Is sedation required for IVC filter removal?
Yes, sedation is typically required for IVC filter removal. Conscious sedation is often used, meaning the patient is relaxed but awake, able to respond to instructions. Sedation helps minimize discomfort and anxiety during the procedure, allowing the patient to remain still, which is important for the safety and success of the retrieval.