Skip to main content

IVC Filters

  • Chapter
  • First Online:
IR Playbook

Abstract

Pulmonary embolism (PE) most often occurs in the setting of lower extremity deep venous thrombosis (DVT) and is a major contributor to morbidity and mortality worldwide. First-line therapy is systemic anticoagulation (AC). In patients who cannot be therapeutically anticoagulated, inferior vena cava (IVC) filters can be placed to provide mechanical clot filtration to prevent PE in the setting of DVT. First introduced in the 1960s, IVC filters have evolved into low-profile devices, which can be deployed percutaneously. A variety of models are available on the market today, including many optional devices, which can be retrieved once the period of venothromboembolism (VTE) risk has elapsed. Standard technique for IVC filter retrieval includes the use of endovascular snares; however, alternative methods such as endobronchial forceps or laser sheath ablation may be needed in complicated cases. Studies have shown the efficacy of IVC filters for reducing the risk of recurrent symptomatic PE but have also revealed an increased risk for DVT and clot propagation. Additionally, there has been increasing recognition of device-related complications, including filter migration, fracture, and penetration through the IVC wall, which can lead to significant clinical sequelae. Consequently, it is essential to place IVC filters in appropriately selected patients and provide vigilant follow-up to remove the filters as soon as clinically indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12(8):464–74.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Grosse SD, Nelson RE, Nyarko KA, Richardson LC, Raskob GE. The economic burden of incident venous thromboembolism in the United States: a review of estimated attributable healthcare costs. Thromb Res. 2016;137:3–10.

    Article  CAS  PubMed  Google Scholar 

  3. Stevens SM, Woller SC, Kreuziger LB, Bounameaux H, Doerschug K, Geersing GJ, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021;160(6):e545–608.

    Article  CAS  PubMed  Google Scholar 

  4. Mobin-Uddin K, Callard GM, Bolooki H, Rubinson R, Michie D, Jude JR. Transvenous caval interruption with umbrella filter. N Engl J Med. 1972;286(2):55–8.

    Article  CAS  PubMed  Google Scholar 

  5. Wingerd M, Bernhard VM, Maddison F, Towne JB. Comparison of caval filters in the management of venous thromboembolism. Arch Surg. 1978;113(11):1264–71.

    Article  CAS  PubMed  Google Scholar 

  6. Greenfield LJ, Zocco J, Wilk J, Schroeder TM, Elkins RC. Clinical experience with the Kim-Ray Greenfield vena caval filter. Ann Surg. 1977;185(6):692–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Johnson MS, Nemcek AA Jr, Benenati JF, Baumann DS, Dolmatch BL, Kaufman JA, et al. The safety and effectiveness of the retrievable option inferior vena cava filter: a United States prospective multicenter clinical study. J Vasc Interv Radiol. 2010;21(8):1173–84.

    Article  PubMed  Google Scholar 

  8. Le Blanche AF, Ricco JB, Bonneau M, Reynaud P. The optional VenaTech() convertible () vena cava filter: experimental study in sheep. Cardiovasc Intervent Radiol. 2012;35(5):1181–7.

    Article  PubMed  Google Scholar 

  9. Lyon SM, Riojas GE, Uberoi R, Patel J, Lipp ME, Plant GR, et al. Short- and long-term retrievability of the Celect vena cava filter: results from a multi-institutional registry. J Vasc Interv Radiol. 2009;20(11):1441–8.

    Article  PubMed  Google Scholar 

  10. Smouse HB, Rosenthal D, Thuong VH, Knox MF, Dixon RG, Voorhees WD 3rd, et al. Long-term retrieval success rate profile for the Gunther Tulip vena cava filter. J Vasc Interv Radiol. 2009;20(7):871–7; quiz 8.

    Article  PubMed  Google Scholar 

  11. Stavropoulos SW, Chen JX, Sing RF, Elmasri F, Silver MJ, Powell A, et al. Analysis of the final DENALI trial data: a prospective, multicenter study of the Denali inferior vena cava filter. J Vasc Interv Radiol. 2016;27(10):1531–8 e1.

    Article  PubMed  Google Scholar 

  12. Ziegler JW, Dietrich GJ, Cohen SA, Sterling K, Duncan J, Samotowka M. PROOF trial: protection from pulmonary embolism with the OptEase filter. J Vasc Interv Radiol. 2008;19(8):1165–70.

    Article  PubMed  Google Scholar 

  13. Mismetti P, Rivron-Guillot K, Quenet S, Decousus H, Laporte S, Epinat M, et al. A prospective long-term study of 220 patients with a retrievable vena cava filter for secondary prevention of venous thromboembolism. Chest. 2007;131(1):223–9.

    Article  PubMed  Google Scholar 

  14. Dake MD, Murphy TP, Kramer AH, Darcy MD, Sewall LE, Curi MA, et al. Final two-year outcomes for the sentry bioconvertible inferior vena cava filter in patients requiring temporary protection from pulmonary embolism. J Vasc Interv Radiol. 2020;31(2):221–30 e3.

    Article  PubMed  Google Scholar 

  15. Kaufman JA, Barnes GD, Chaer RA, Cuschieri J, Eberhardt RT, Johnson MS, et al. Society of Interventional Radiology Clinical Practice Guideline for inferior vena cava filters in the treatment of patients with venous thromboembolic disease: developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine. J Vasc Interv Radiol. 2020;31(10):1529–44.

    Article  PubMed  Google Scholar 

  16. Angel LF, Tapson V, Galgon RE, Restrepo MI, Kaufman J. Systematic review of the use of retrievable inferior vena cava filters. J Vasc Interv Radiol. 2011;22(11):1522–30 e3.

    Article  PubMed  Google Scholar 

  17. Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. 1998;338(7):409–15.

    Article  CAS  PubMed  Google Scholar 

  18. Group PS. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study. Circulation. 2005;112(3):416–22.

    Article  Google Scholar 

  19. White RH, Brunson A, Romano PS, Li Z, Wun T. Outcomes after vena cava filter use in noncancer patients with acute venous thromboembolism: a population-based study. Circulation. 2016;133(21):2018–29.

    Article  CAS  PubMed  Google Scholar 

  20. US Food and Drug Administration. Inferior Vena Cava (IVC) filters: initial communication. Risk of adverse events with long term use 2010 [updated August 9, 2010]. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm221707.htm.

  21. US Food and Drug Administration. Removing retrievable inferior vena cava filters: FDA Safety Communication 2014 [updated May 6, 2014]. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm.

  22. Ahmed O, Wadhwa V, Patel K, Patel MV, Turba UC, Arslan B. Rising retrieval rates of inferior vena cava filters in the United States: insights from the 2012 to 2016 summary medicare claims data. J Am Coll Radiol. 2018;15(11):1553–7.

    Article  PubMed  Google Scholar 

  23. Karp JK, Desai KR, Salem R, Ryu RK, Lewandowski RJ. A dedicated inferior vena cava filter service line: how to optimize your practice. Semin Intervent Radiol. 2016;33(2):105–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Winters JP, Morris CS, Holmes CE, Lewis P, Bhave AD, Najarian KE, et al. A multidisciplinary quality improvement program increases the inferior vena cava filter retrieval rate. Vasc Med. 2016;22:51.

    Article  PubMed  Google Scholar 

  25. Ray CE Jr, Mitchell E, Zipser S, Kao EY, Brown CF, Moneta GL. Outcomes with retrievable inferior vena cava filters: a multicenter study. J Vasc Interv Radiol. 2006;17(10):1595–604.

    Article  PubMed  Google Scholar 

  26. Iliescu B, Haskal ZJ. Advanced techniques for removal of retrievable inferior vena cava filters. Cardiovasc Intervent Radiol. 2012;35(4):741–50.

    Article  PubMed  Google Scholar 

  27. Stavropoulos SW, Ge BH, Mondschein JI, Shlansky-Goldberg RD, Sudheendra D, Trerotola SO. Retrieval of tip-embedded inferior vena cava filters by using the endobronchial forceps technique: experience at a single institution. Radiology. 2015;275(3):900–7.

    Article  PubMed  Google Scholar 

  28. Kuo WT, Doshi AA, Ponting JM, Rosenberg JK, Liang T, Hofmann LV. Laser-assisted removal of embedded vena cava filters: a first-in-human escalation trial in 500 patients refractory to high-force retrieval. J Am Heart Assoc. 2020;9(24):e017916.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kesselman AJ, Hoang NS, Sheu AY, Kuo WT. Endovascular removal of fractured inferior vena cava filter fragments: 5-year registry data with prospective outcomes on retained fragments. J Vasc Interv Radiol. 2018;29(6):758–64.

    Article  PubMed  Google Scholar 

  30. Puller HF, Stavropoulos SW, Trerotola SO. Stability of retained inferior vena cava filter fragments after filter removal. J Vasc Interv Radiol. 2021;32(10):1457–62.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. William Stavropoulos .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chen, J.X., Stavropoulos, S.W. (2024). IVC Filters. In: Keefe, N.A., Haskal, Z.J., Park, A.W., Angle, J.F. (eds) IR Playbook. Springer, Cham. https://doi.org/10.1007/978-3-031-52546-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-52546-9_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-52545-2

  • Online ISBN: 978-3-031-52546-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics