A review of inferior vena cava filters

Abstract

The care of patients with venous thromboembolism (VTE) is delivered via a multidisciplinary team. The primary treatment for VTE is anticoagulation; however, placement of filter devices in the inferior vena cava (IVC) to prevent embolisation of deep venous thrombosis (DVT) is a well-established secondary treatment option. Many controversies remain regarding utilisation and management of filters.

Figure 1.

The ALN Filter (Implants Chirurgicaux, France) is our current filter of choice.

Figure 2.

Celect® (Cook) IVC filter removed with retrieval snare set in a 31-year-old male with a history of PE, testicular cancer and retroperitoneal lymph node dissection. (a) After first performing a venogram to ensure no thrombus is present in the filter, the looped snare is manipulated down over the hook. (b) The snare has been tightened around the hook and (c) the sheath is pushed down over the filter while holding the snared filter firmly until the filter is within the sheath. The filter is then removed through the sheath. IVC, inferior vena cava; PE, pulmonary embolism.

Figure 3.

ALN IVC filter retrieval in a 77-year-old lady who had a DVT and needed interruption of anticoagulation for a neurosurgical procedure. (a) 6 weeks after the surgery, the ALN retrieval device was used for retrieval (grasping device with curve on the end of the delivery sheath to facilitate removal of filters tips close to the caval wall). The grasper of the retrieval device is seen directed over the hook of the filter. (b) Once the grasping device has engaged the filter tip, it is closed around it and the sheath advanced over the filter, which is then withdrawn. IVC, inferior vena cava; DVT, deep venous thrombosis.

Figure 4.

Example of a difficult retrieval. Initial standard retrieval methods had failed as (a) the filter had tilted against the wall of the IVC and endothelialised. (b) Using a long 16 Fr sheath and a Rim catheter (AngioDynamics, New York) , a 300 cm x 0.014 inch pilot wire was looped through the struts of the filter. (c) The 0.014 inch guidewire was then snared using a filter removal loop snare. The guidewire was brought out through the sheath to the skin so that a long loop of guidewire is present from the skin to the tip of the filter. (d) The filter was straightened by pulling both ends of the guidewire and the sheath was advanced over the hook and the filter removed. IVC, inferior vena cava.

Figure 5.

51-year-old lady with unprovoked above knee DVT, saddle pulmonary embolus, and intracranial bleed had an IVC filter inserted. Multiple attempts were made to remove the filter with standard snare techniques, but the hook of the filter was embedded in the anterior wall. (a) Attempts at removing the filter caused an arm strut to bend cranially. (b) The patient had a 16 Fr long sheath placed through which an ENT forceps, which was manually curved before insertion, was manipulated on to the hook at the top of the filter and the hook grasped. (c) While keeping the forceps closed around the hook of the filter, the sheath was manipulated down over the filter and the filter removed. (d) The filter and ENT forceps are shown ex vivo. IVC, inferior vena cava; DVT, deep venous thrombosis.

Figure 6.

Axial CT demonstrates IVC filter wall penetration of an anchoring strut toward the duodenum on the right. IVC, inferior vena cava.

Figure 7.

Coronal CT image demonstrates IVC thrombus below the filter. IVC, inferior vena cava.