When a deep vein thrombosis (DVT) or blood clots form in the leg, patients are treated with blood thinners (anticoagulants) to stop any additional clot from forming and to prevent the clot from travelling to the heart and lungs where they can cause serious and sometimes fatal complications (pulmonary embolism or PE).
Not all patients are able to take anticoagulants, especially if they are elderly, had recent major surgery, they have a history of bleeding or have developed more clots on blood thinner treatment. Though some smaller blood clots may not pose much risk, a large enough blood clot traveling to the lung can plug and stop the blood flow to the lungs and heart resulting in chest pain and difficulty breathing. To avoid any clot from reaching the lungs, a special metal filter can be placed in the inferior vena cava or IVC (a large vein in your abdomen which connects your leg veins to the heart) to protect you from a pulmonary embolism. This device is called a vena cava filter.
When is a filter indicated?
If you are unable to be on blood thinners, our vascular specialists will discuss with you the indications, benefits, and risks of placing an IVC filter. The following are some of the common indications to place an IVC filter:
- Failure of your blood thinner to stop clot formation
- High risk of bleeding if blood thinners are started e.g. trauma patients, surgery
- Active bleeding
- Low platelet count
- Unstable clot in the leg or pelvic veins
- High risk of falling, especially in elderly patients
How is the procedure done?
Your vascular surgeon will insert the filter into your vena cava through a catheter placed into your groin or neck vein which connects to the IVC. At South Charlotte General and Vascular Surgery, our vascular specialists are able to insert the filter in our fully accredited state of the art angiography suite without having to be hospitalized. Many times these filters are placed temporarily and can easily be removed.
Our team will prepare you for the procedure and after you sign your informed consent. You will then be moved to the procedure room and the team will cleanse your groin skin or neck with antiseptic and drape you with a sterile field. Your surgeon will then inject an anesthetic into the skin to numb the area and prevent pain. A catheter (a thin plastic tube) is then placed into the vein (inferior vena cava) for inserting the filter and guided under X-ray to the site where the filter will be deployed. An injection of a liquid dye will enable your surgeon to see the vein to ensure the filter is placed precisely. As the contrast material passes through your body, you may get a warm feeling. Our facility also offers a non-iodine based contrast solution (IVUS or CO2) when your kidneys are in a delicate state (Chronic Renal Failure). The filter will then be released in its position and the catheter removed from your groin or neck and gentle pressure applied to stop any bleeding.
How is the filter removed?
The IVC filter is removed in a similar fashion with a special catheter which is inserted into a large vein in the neck or groin and advanced to the site of the filter in the vena cava. The removable IVC filter has a small hook at one end that enables your surgeon to capture it with the catheter and withdraw it from the body. Prior IVC filters, not placed by our surgeons, may also be removed if necessary.
What are the risks of the procedure?
In most patients, placing an IVC filter is a safe procedure but, although rare, some complications may occur:
- Allergic reactions to the liquid dye particularly if you have iodine or shell-fish allergy. If you have such an allergy, please let the team know before the procedure.
- IVC filter can lodge in the wrong place, change position or penetrate through the vein (which can lead to injury of a nearby organ).
- The IVC filter or a piece of the IVC filter may break loose and travel to the heart or lungs causing injury or death.
- Blockage of the vein if the filter has been in there for a very long time or if it captures very big clots
- Pulmonary embolism despite the filter being in place
The risks are greater if the filter remains in place for a longer period of time.
If you have a filter and experience abdominal pain or shortness of breath should seek urgent medical attention.
How should I prepare?
Prior to your procedure, your blood may be tested to determine how well your kidneys are functioning and whether your blood clots normally.
- You should eat a light meal the night before your procedure (nothing by mouth the morning of the procedure) and take your medications as usual except if you take insulin or metformin. Our team will instruct you on how much insulin to take or when to stop and resume your metformin.
- Please let the team know of any recent illnesses or other medical conditions. You may need to receive an antibiotic before the procedure if you have an active infection or at very high risk for infections.
- Women should always inform the team if there is any possibility that they may be pregnant.
- You should plan to have a relative or friend drive you home after your procedure.
How long will it take, and will I be able to resume normal activities?
You will remain in the recovery room where our team will monitor your vitals and ensure your comfort until it is safe for you to return home. If your IVC filter was inserted through a vein in your neck, you will be able to resume your normal activities within 24 hours. If your filter was inserted through a vein in your groin, you should avoid driving and climbing stairs for 24 hours. You should also avoid heavy lifting for 5 days.
Our team will give you detailed instructions before you leave the office, and a follow-up appointment will be scheduled.
At South Charlotte General and Vascular Surgery, we are committed to your vascular health. Please, let us know if your experience with us has been less than perfect.