Centers of Excellence in Interventional Cardiology and Radiology

Interventional radiology

Inferior vena cava filters placement


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Thromboembolic disease is caracterized, especially, by clots formation in deep venous system of legs and their migration in the pulmonary arteries.

There are many causes of clots formation, wich are included in three categories:

1. blood stagnation in legs ( because of insuficiency of venous circulatory system, after surgical procedures associated with prolonged bed repose, but also in case of prolonged travels – including plane, car)

2. affecting of vein’s walls – veins of legs or pelvic veins ( this condition may be associated with pregnancy and birth)

3. hypercoagulable state ( tendency of blood to form clots) – there are some genetic disorders, such as: factor V Leyden mutation, prothrombin gene mutation, low activity of some proteins wich are natural inhibitors of clots formation. This condition can be also acquired – in pregnancy, in case of use of oral contraceptives drugs, especially associated with smoking, but also in neoplastic diseases.

When clots are formed in veins of legs you feel observe leg’s swelling (because the blood’s stagnation), pain in rest but also associated with movements, local warmth and, in some severe cases, the arterial circulation of legs may be afected and this is leading to ischemic lesions of legs. Clots can migrate through venous system reaching right heart chambers and from this point, clots they can migrate in pulmonary arteries, condition know as pulmonary embolism. Because of the clots, blood can’t pass from pulmonary arteries in capillary vessels, pulmonary veins and forward in left heart, so there will be a low cardiac debit, wich can be life threatening.

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Thromboembolic disease can evoluate without any symptom and can lead to sudden death. We all know about people who have traveled with plane long distances, for 10-12 hours and after they have died because of pulmonary embolism.

Pulmonary embolism treatment is deppending of disease’s severity. So, some patients ( whit low blood pressure secondary to low cardiac debit) may beneffit by thrombolitic treatment or surgical remove of clots from pulmonary arteries. Anyway, most of patients diagnosed with pulmmonary embolism are eligible for anticoagulant treatment, wich helps the body to disolve clots – this is a long process ( weeks – months).

Modern medicine talks about prevention of pulmonary embolism in patients having a high risk for development of this disease. This target can be achieved by anticoagulant treatment (either subcutaneous anticoagulant, either oral anticoagulant).

Sometimes, the anticoagulant treatment is not an option ( because of contraindications or because of high risk of bleeding, such as: cerebral tumors having a reach vascularisation, in case of neurosurgical procedures or active bleedings).

For these patients there is another option: vena cava filters placement – this is a mechanical way to decrease the risk of developping or recurrence of pulmonary embolism, because of clots holding back by the filter.

Vena cava filters can be:

1. permanents – after their implantation they can’t be removed; these devices are indicated for patients at high, contiuous risk for pulmonary embolism, without possibility to attend an anticoagulant treatment

2. temporary – these devices can be removed after their placement; they are indicated for patients with temporary contraindication for anticoagulant treatment


deep vein thrombosis in patients with contraindications or complications of anticoagulant treatment, but also at high risk for development or recurrence of pulmonary embolism. Vena cava filters decrease the risk of pulmmonary embolism, but they don’t decrease the risk of deep vein thrombosis.

Because there is not a certain indiccation for vena cava filters implantation, you shloud know that every case has his particularity, so the decision for vena cava filters placement will be made according to case, but also patient’s particularities:

• deep vein thrombosis involving ileo-cava veins ( there is a high risk for clots migrations in pulmonary arteries)

• a mobile, big thrombus

• hard to maintain an anticoagulated status in thromb

• Vena cava filters placement can be also prophylactic: for patients at high risk to develop deep vein thrombosis, such as neoplastic patients, patient with indication for majore surgicals procedures.


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Vena cava filters placement is performed in our Center of Excellence, in the catheterism labs, by our radiologist or cardiologist who are also specialized in interventional techniques.

The procedure is performed under local anesthesia ( with xilin), respecting the asepsy rules. You will receive aslo heparin iv (a drug wich prevents clots). The doctor will place the filter using vein approach – either your femoral vein, either neck’s veins.

After local anesthesia (with xilin) and local asepsy, your doctor puncture the vein and then inserts a sheath into the vein (a thin, plastic device). Then, a catheter (a tiny plastic tube) is advanced into this sheath , using constrast matherial and fluoroscopic guidance. This catheter has attached at his extremety the filter ( at this point the filter is folded). All the manoeuvres are performed under X ray guidance. When the filter is in the proper position, it will be released. The filter will extend and will be fixed in vein’s wall. His position is constantly verified by imaging techniques ( fluoroscopic guidance).

When the procedure is done, the sheath is removed, and the asistent will press the puncture place for 10 minutes, in main to obtain hemostasis, and after will make a compressive dressing.

Is it painful?

The doctor will use local anesthesia, with xilin, wich may induced local warmth for 10-20 seconds. You will not feel any pain associated with all puncture manoeuvres. You may also feel some disturbance when the filter is released and fixed, but this sensation is transient.

How long does it take?

The procedure lasts between 30minutes and 1 hour.


The complications are rare; the complications are reduced by the proper preparation and the continuous surveillance of the patient. Potential complications:

Allergic reactions to administered substances

Reactions to anesthetic compounds

Arteriovenous fistulas, hematomas or bleedings at the vascular puncture site

Fever and local infection

Cardiac arrythmias

incorrect device placement.

Long term complications include:

increase of risk of deep vein thrombosis

inferior vena cava thrombosis and pulmonary embolism

inferior vena cava perforation

device migration.

Before procedure

Hospitalization for 24 hours is required. You will be admitted the day before the intervention. You will be asked to fast for eight hours before the procedure, generally after midnight.

Prior to the intervention, your doctor must be prevented about any history of allergic reactions. Blood tests are taken including hemoglobin level, coagulation, renal function, and other specific tests.

Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. You will be asked to sign a consent form that gives permission to do the procedure.

Notify your doctor if you are sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general). Also, do not interrupt your anticcoagulant treatment.

After procedure

You will be conducted to your room and connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. You will be given pain medication.

You can move after 1 hour. The dressing will be also removed after 1 hour.

You should also drink a lot of fluids.


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Vena cava filters implantation is a modern way to decrease the risk of pulmonary embolism in patients at with transient or permanent contraindications for anticoagulant treatment, but also in patients who have an history for major caomplications associated with this kind of treatment.

The procedure has a very low risk for both early and tardive complications (<1% of cases).

Because this procedure is performed under local anesthesia and is a minimally invasive technique, the recovery is fast.

Anyway, after procedure a proper, periodic evaluation is mandatory.

Sună Mesaj