IVC filter is a small metal device which is placed in inferior vena cava to prevent blood clots from moving through blood into the lungs

1. IVC Filter
By : Masoud.Sajjadi
Consultant Interventional Cardiologist at Razavi Hospital
Mashhad , Iran
April 2022

2. 1. IVC Filter Location
2. IVC Filter Types
3. Indications
4. IVC Filter Studies
5. Complications
6. IVC Filter Deployment
7. IVC Filter Retrieval
Table of Contents

3. IVC Filter
Location

4. IVC Filter Location

5. IVC Filter
Types

6. ALN
Optease

7. IVC Filter Types

8. IVC Filter Types

9. OptEase (Cordis)

10. IVC Filter Types

11. IVC Filter
Indications

12. IVC Filter Indications
( ESC Guideline 2019 )

13. 1. Acute VTE patients ( regardless of the size or
clinical severity of the VTE ) with Contraindications
to Anticoagulation
2. Recurrent PE despite Therapeutic
Anticoagulation
3. IVC filter should be considered Individual basis for
patients with Intermediate-or high-risk PE who
tolerating therapeutic anticoagulation
IVC Filter Indications
Ref : Braunwald 2022

14. IVC Filter
Studies

15. IVC Filter Studies
JACC 2017

16. IVC Filter Studies
JACC 2017

17. IVC Filter Studies
Meta-analysis of RCTs ( JACC 2017 )
IVC Filter
 Reduce the short-term risk of subsequent PE
 Increase long-term risk for DVT
 No impact on Overall Mortality

18. IVC Filter
Complications

19. IVC Filter Complications
1. Strut Fracture
2. Filter Migration
3. Strut Embolization
4. Device Tilt
5. IVC penetration
6. Perforation of surrounding structures
7. PE, DVT & IVC thrombosis
Ref : Braunwald 2022

20. IVC Filter Complications
 To Avoid these Complications, IVC filters should be Retrieved as
soon as no longer necessary and after anticoagulation has been
safely started
 Retrievable IVC filters can be removed Safely and Easily , yet up to
50% remain permanently indwelling
Ref : Braunwald 2022

21. Small Bowel Penetration

22. IVC Filter Tilting

23. IVC Filter
Deployment

24. Procedure
1. Preprocedural imaging : CDS of both lower extremities and IVC
2. Access : Contralateral to DVT location
3. IVC Filter location : Between IVC bifurcation ( Level of L5 Vertebra ) & Renal veins ( Level of L1-L2 disk )
4. Sheath : 6F
5. Long GW is preffered for advancement through Needle
6. Tube position ( 0 . 0 )
7. Injection via Femoral sheath for evaluation of Iliofemoral vein ( DSA Mode )
8. Advancement of long GW over femoral sheath
9. Replacement of femoral sheath with IVC Filter sheath ( 65 cm )
10. Sheath Inserion ( Injection via Sheath , Note Renal Veins )
11. Put IVC filter from Femoral side inside the sheath ( Optease )
12. Push the IVC filter by Pusher
13. IVC Filter deployment in CINE ( table should not be moved )
14. Final Injection via Sheath ( DSA mode )
15. Sheath Removal

25. IVC Filter Deployment

26. IVC Filter

27. IVC Filter
Retreival

28. IVC Filter Retrieval
To Avoid Complications of In-Situ filters
Removal is Indicated when the filter is No longer Needed

29. IVC Filter Retrieval

30. IVC Filter Retrieval
Perform Cavogram before IVC Filter Removal for detection of
In-situ IVC filter thrombosis
1. Standard technique ( Loop Snare technique )
2. Advanced techniques
A. Buddy-wire technique ( wire displacement technique )
B. Modified Loop Snare technique ( Hangman technique )
C. Balloon Displacement technique
D. Bidirectional loop-snare technique
E. Rigid Endobronchail forceps - assisted technique
F. Laser-assisted sheath technique

31. IVC Filter Retrieval
( Standard technique )

32. IVC Filter Retrieval
( Buddy-wire technique )

33. IVC Filter Retrieval
( Balloon Displacement technique )

34. IVC Filter Retrieval
( Bidirectional loop-snare technique )

35. IVC Filter Retrieval
( Rigid Endobronchail forceps - assisted technique)

36. IVC Filter Retrieval
( Laser-assisted filter retrieval )

37. IVC Filter Retrieval
( Laser-assisted filter retrieval )

38. Thanks for
Your
Attention