Inferior Vena Cava Filter - Placement

Placement

IVC filters are placed endovascularly, meaning that they are inserted via the blood vessels. Historically, IVC filters were placed surgically, but with modern filters that can be compressed into much thinner catheters, access to the venous system can be obtained via the femoral vein (the large vein in the groin), the internal jugular vein (the large vein in the neck) or the arm veins with one design. Choice of route depends mainly on the number and location of any blood clot within the venous system. To place the filter, a catheter is guided into the IVC using fluoroscopic guidance, then the filter is pushed through the catheter and deployed into the desired location, usually just below the junction of the IVC and the lowest renal vein.

Review of prior cross-sectional imaging or a venogram of the IVC is performed before deploying the filter to assess for potential anatomic variations, thrombi within the IVC, or areas of stenoses, as well as to estimate the diameter of the IVC. Rarely, ultrasound-guided placement is preferred in the setting of contrast allergy, renal insufficiency, and when patient immobility is desired. The size of the IVC may affect which filter is deployed, as some (such as the Birds Nest) are approved to accommodate larger cavae. There are situations where the filter is placed above the renal veins (e.g. pregnant patients or women of childbearing age, renal or gonadal vein thromboses, etc.). Also, if there is duplication of the IVC, the filter is placed above the confluence of the two IVCs or a filter can be placed within each IVC.