Inferior Vena Cava Filter Insertion and Removal
This sheet provides information about the procedure of inserting and removing an inferior vena cava (IVC) filter. It will cover what the procedures involve, the potential risks and what to expect when you come for the procedure.
Please note that this leaflet is not meant to replace discussion between you and your doctor. You should raise any questions you may have with the doctor who has referred you for, or is performing, the procedure.
What is an IVC Filter?
An IVC filter is a small implantable metallic device that is inserted into the inferior vena cava (IVC), the large vein that drains blood from the lower part of the abdomen and legs back to the heart.
The shape of the filter allows normal blood to flow through it but acts as a barrier to any blood clots. These clots cannot travel back up to the heart or onwards to the blood vessels of the lung. IVC filters can either be permanent or retrievable (temporary), the latter of which may be removed at a later stage.
Why do I need an IVC Filter?
Venous thromboembolism (VTE) is the process of blood clot formation in the veins of the body. A clot is a semi-solid mas of blood cells and other substances that form is in a blood vessel. Clots can form in the veins of the limbs, mainly the legs, a condition called deep vein thrombosis (DVT). These clots can break off and travel up the body into the pulmonary arteries (the vessels supplying blood to the lungs). When this happens, the condition is termed pulmonary embolism (PE), which can be fatal.
The most common way of treating DVT and PE is through medications that thin the blood, so called ‘anticoagulants’. These medications can be administered through injections (low molecular weight heparin) or tablets (warfarin or direct oral anticoagulants, DOACs).
Anticoagulants cannot be given to some patients due to risks associated with their other medical conditions. In other cases, blood clots may continue to develop despite anticoagulant therapy. Some patients develop complications associated with these medications. IVC filter insertion can be considered for these groups of people, to prevent blood clots travelling up to the lungs.
The type of IVC filter will depend on your clinical circumstances. Permanent filters cannot be removed so are used mainly in patients with long-term reasons for not being on anticoagulation. Retrievable filters are used in circumstances where patients have a temporary reason and are removed after the necessary time-period.
Rarely IVC filters may be inserted in patients who have do not have a DVT or PE at the time but are at high risk of developing them. This is not as common, and your doctor should explain the reasons for this treatment.
Other management options for DVT and PE include ‘clot busting’ medication (so called thrombolysis) which can be administered through a drip (intravenous thrombolysis), or through a small tube inserted into the blood vessels (catheter thrombolysis), clot removal therapy (thrombectomy) and surgery.
How do I prepare for an IVC Filter Insertion or Removal?
IVC filter insertion and removal procedures are usually performed as a day case by the interventional radiology team under local anaesthetic or light sedation.
Your doctor will explain and discuss the procedure beforehand to obtain your consent and answer any questions you may have. Remember that you can decide to not go ahead with the procedure at any stage.
They may ask about the medications you take and will provide information about eating and drinking prior to the procedure. Typically, it is advised to not eat for 6 hours before the procedure, but you may still drink clear fluids like water.
It is important before your procedure that you notify your doctor or the radiology team of any allergies you have, including previous reactions to contrast agent dye and anaesthetic. You should also inform the team if you are feeling unwell on the day or if you think you could be pregnant.
Who performs the procedure and where?
IVC filter insertion and removal is normally carried out by an interventional radiologist, a doctor who specialises in interpreting scans to aid diagnosis and using imaging to guide catheters and wires to treat these conditions. They will be accompanied by other allied health professionals in the team such as nurses and radiographers.
The procedure will take place in the radiology department, in an angiography suite. These rooms are like an operating theatre, but also have specialised imaging equipment which are used during the procedure.
How is an IVC Filter insertion/removal performed?
On the day, you will be met by the team who will confirm your details, check your vital signs, and will ask you to change into a hospital gown. A cannula (small plastic tube) will be inserted, typically into your arm, to administer medications if required.
You will then be asked to lie flat on the x-ray operating table, normally on your back. You will normally have monitoring equipment attached looking at your oxygen levels, heart rate and blood pressure.
As the procedure is performed under sterile conditions, the interventional radiologist and assisting nurse will clean their hands and where a sterile gown and gloves. They will clean the incision site, normally the neck or the groin, with antiseptic liquid, and you will be covered with sterile drapes.
Local anaesthetic will be injected into the skin and deeper tissues overlying the puncture site to numb the area. A scalpel may be used to make a small nick in the skin. Following this, a thin plastic tube (catheter) will be inserted into the vein. X-ray scanning and contrast agent dye injection will help guide the catheter to the right position.
IVC Filter Insertion: The IVC Filter will be passed through the catheter to the target location and will be released. The filter has small hooks to lock it in place on the wall of the vein.
IVC Filter Removal: Specialised equipment to “grab” the IVC filter will be deployed through the catheter and collapse it to allow removal.
Once the IVC filter has been inserted or removed, the doctor will press on the skin site and it may be covered with a dressing.
The procedure length can vary from patient to patient, but you should expect to be in the radiology department for around an hour.
What are the potential risks or complications of IVC Filter Insertion?
Overall IVC filter insertion and removal are safe procedures, and serious complications are rare. Bleeding, bruising or infection may occur at the skin puncture site.
Serious insertion complications include incomplete opening, misplacement or ‘tilting’ of the IVC filter. Later down the line, very rare complications can occur such as migration and damage of the filter or damage to the vein that the filter attaches to. Blood clots may form in the filter, which can block blood flow in the vein or travel to the vessels of the leg or lung, causing a DVT or PE.
You may require another procedure to remedy any complications.
What happens afterwards?
Immediately after the procedure you will be taken back to the ward. The nursing staff will take routine observations and monitor the treatment site. Normally, you will stay in bed for a few hours, following which you will be able to go home. It is advised to rest for the remainder of the day, but you can resume normal activities the next day.
Permanent IVC filters will remain in your body, and you may need to take long-term anticoagulant medication to prevent any further blood clots, which your doctor will advise you on.
For retrievable (temporary) filters, you will be contacted to arrange a date for removal. Please contact the department if you have not heard anything six weeks after insertion.
Remember that the filter is normally made of metal. It is important that you notify the scanning team that you have an IVC filter if you ever need a magnetic resonance imaging (MRI) scan in the future.
You can print off this information as a PDF, using the link below:
