This document outlines the steps for placing an IVC filter. The procedure involves: 1) obtaining access through the femoral vein using a micropuncture needle and guidewire; 2) performing a venogram to visualize the IVC; 3) advancing the delivery device containing the collapsed filter through the introducer sheath and deploying the filter below the renal veins under fluoroscopy; and 4) removing the delivery device and sheath and obtaining a final venogram to confirm placement of the filter in the IVC. Indications for IVC filter placement include preventing pulmonary embolism in patients where anticoagulation is contraindicated or has failed to prevent recurrent PE.

1. IVC Filter Placement How I Do It

2. Pre-op 1. Indication PE when anticoags are contraindicated Failure of anticoags for thromboemboloic dz Chronic, recurrent PE where anticoags failed or contraindicated Contraindications IVC diameter > 28mm (G2) IVC diameter > 30mm (optease)

3. Procedure 2. Access Prep, drape, local Nick skin Palpate femoral pulse Micropuncture medial to pulse Insert J wire into IVC Remove needle over J wire Advance introducer sheath with dilator over guidewire

4. Procedure 3. Venogram 15/30 4. Separate dilator and introducer Remove guidewire and dilator 5. Remove safety cap. Advance delivery device through introducer sheath until hubs snap together 6. Place below renal v 7. Deploy filter 8. Remove delivery device 9. Venogram to confirm placement 10. Remove introducer sheath and hold pressure

5. Procedure