Inferior Vena Cava Filter Insertion
Date issued: November 2024
For review: November 2026
Ref: B-251/Imaging/RA/Inferior vena cava filter insertion v2
PDF: Inferior vena cava filter insertion.pdf [pdf] 225KB
This leaflet tells you about having an inferior vena cava (IVC) filter inserted. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to a Radiologist for this procedure. Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form, if one hasn’t been previously completed. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then they will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is an IVC filter?
An IVC filter is a small metal device usually placed in a large vein called the Inferior Vena Cava (IVC) that drains blood from the legs and lower part of the abdomen. The IVC filter allows blood to flow through normally but traps any large blood clots, stopping them from getting to your lungs. Filters are often removed within 3 months or as soon as they are no longer required.
What is it used for?
Blood clots (thrombosis) sometimes form in the veins of the legs and pelvis. They are known as a Deep Vein Thrombosis (DVT). The clot can sometimes break free and enter with the blood flow into the lungs and make you very sick. This is called Pulmonary Embolism (PE). They can be fatal. An IVC filter prevents a large PE by trapping a clot before it reaches the lungs.
Who should have an IVC filter?
The usual treatment for DVT and PE is drug treatment to thin the blood. This is usually with warfarin. In a few patients, warfarin does not prevent further PEs, in others thinning the blood is too risky. When this happens, patients are considered for treatment by inserting an IVC filter.
Very occasionally, a patient is advised to have an IVC filter inserted even though they do not have a DVT or PE at that time. Your doctors will explain the reasons why they think you should have an IVC filter.
Are there any risks?
IVC filter insertion is a very safe procedure. Serious complications are very rare. There may be a small bruise at the needle site and very rarely there may be damage to the vein or blockage of the inferior vena cava. If blocked, then significant leg swelling will occur.
Extremely rarely, the filter can migrate which may require a further procedure to reposition the IVC filter. If the filter cannot be retrieved then this can cause significant problems, including death.
The filter can fracture (break) and travel to the heart or lungs.
The filter legs can very occasionally penetrate through the IVC wall causing damage to other structures.
If you need a Magnetic Resonance (MRI) scan in the future, you should tell the person doing the scan that you have a filter.
Inserting (and removing) an IVC filter does not guarantee that you will not have PEs in the future.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
Insertion of an IVC filter can be carried out as a day case or inpatient procedure under local anaesthetic.
You may eat and drink as normal unless sedation has been discussed beforehand with the referring team/radiologist.
Before coming into hospital, you will have been asked about certain risk factors for vascular disease, unless you have to come into hospital as an emergency. These factors include checking your blood pressure; your kidney function and making sure you are not on treatment for diabetes or blood clots.
If you are taking warfarin, this will be stopped before the procedure and you may require admission to hospital to give you an alternative. If you are diabetic, your doctors will advise you about any changes needed to your normal medication. If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
Who will you see?
A specially trained team led by an Interventional Radiologist within the radiology department. Interventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
If you are having the procedure as a day case, then you will attend PIU/Postbridge ward prior. You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) may be placed into a vein in your arm.
Our porters will collect you and bring you to the interventional radiology suite which is located within
X-ray East. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during the insertion?
The Interventional Radiologist will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
You will lie on the X-ray table, generally flat on your back. A needle will be inserted into a vein in your arm, so that a sedative or painkillers can be given if required. You may have monitoring devices attached to your chest and finger and may be given oxygen.
The procedure is performed under sterile conditions and the Interventional Radiologist and radiology nurse will wear sterile gowns and gloves to carry out the procedure. The skin near the point of insertion, either the neck or the groin, will be swabbed with antiseptic and you will be covered with sterile drapes.
The skin and deeper tissues over the vein will be numbed with local anaesthetic. A fine tube (catheter) will be inserted and guided, using the X-ray equipment into the correct position. Small amounts of dye (contrast agent) are used to check the position of the catheter. The filter is passed through the tube to the exact site and released. Small hooks grip the wall of the vein and stop it moving away.
Will it hurt?
It may sting a little when the local anaesthetic is injected. You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine.
How long will it take?
Every patient's situation is different, and it is not always easy to predict. As a guide, expect to be in the X-ray department for about an hour.
What happens afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You will generally stay in bed for a few hours, until you have recovered.
Take it easy for the rest of the day but you can resume normal activities the next day.
How long will the filter stay in?
Modern IVC filters can be left in permanently; however, it is becoming more common for these devices to be a temporary solution and removed when they are no longer required. This is often at three months but may occasionally be longer.
Other Risks
IVC filter placement is a very safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 430838 - IR Co-ordinator
01752 432063 – Bookings Clerk
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Mon-Sat (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
Comments and Suggestions
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