VENOUS VARIA

IVC FILTER REMOVAL

Introduction

Last updated: apr 5, 2025

Timely retrieval of IVC filters is crucial to prevent complications such as filter fracture, vena cava perforation, migration, fragment embolization, and thrombosis of the inferior vena cava.

The FDA recommends that IVC filters be removed within 25-54 days of their implantation

Caval Anatomy

Number 1 indicates iliac segment arises from the posterior cardinal veins; 2, subrenal segment arises from the right supracardinal vein; 3, renal segment arises from the anastomosis between the right supracardinal and subcardinal veins; 4, suprarenal segment arises from the right subcardinal vein; and 5, hepatic segment arises from the hepatocardiac canal.

 

Anatomy

File NameTypePermissionsChanged DateDateSize

Cava Filter Removal Window
 

Indications

The FDA recommends that IVC filters be removed within 25-54 days of their implantation

 

Contra indications

Absolute

  • Ongoing risk of pulmonary embolism without adequate anticoagulation
  • Inability to safely access the filter due to anatomical changes or thrombosis.
  • Significant thrombus in or around the filter (> 25%), increasing the risk of embolization during retrieval.
  • Filter embedded in the IVC wall or tilted with endothelial overgrowth that poses high risk for vessel damage on retrieval.
  • Infection at the insertion site or systemic sepsis, until resolved.

Relative

  • Severe comorbidities where the risk of procedure outweighs benefit.
  • Chronic indwelling filters with high degree of integration into the IVC wall (technical difficulty increases over time).
  • Patient refusal or lack of informed consent.
  • Pregnancy, depending on the situation and timing.

 

Materials

Essentials

  • Standard angio set
  • Introducer 12F
  • Disinfectant
  • Snare, preferably basket type
  • Filter catheter 11 F

Non-Essentials

 

Positioning the patient

  • Head first
  • Supine

 

The procedure in steps

  • Time out
  • Sterile washing
  • Draping
  • Ultrasound-guided venipuncture
  • 10F sheath
  • Cavogram should show thrombus load < 25%
  • Retrievel with snare
  • Remove sheath
  • Manual compression

 

Tips and tricks

See article below

  • Centering Techniques
  • Coaxial Double-Sheath Dissection
  • Laser-Assisted Double-Sheath Dissection

File NameTypePermissionsChanged DateDateSize
pdf
 Advanced IVC Filter Retrieval Techniques pdf 0644 2025070109252801-Jul-2025 09:25 2025050302504803-May-2025 02:50 481 KB Preview Print Download

 

Complications

Published rates for individual types of complications are highly dependent on patient selection and are, in some cases, based on series comprising several hundred patients, which is a volume larger than most individual practitioners are likely to treat. It is also recognised that a single complication can cause a rate to cross above a complication-specific threshold when the complication occurs in a small volume of patients, e.g. early in a quality improvement programme.

Clinically significant penetration and migration are felt to be rare. The rate of clinically significant penetration is undefined in the literature.

ComplicationReported rate (%)Threshold (%)
Death0,12<1
Recurrent PE0,5-65
IVC Occlusion2-3010
Filter embolisation2-52
Access site thrombosis0-61
Migration0-18
Fracture2-10
Perforation0-41
 

Post-op

  • Removal in consultation with the treating physician, the FDA recommends that IVC filters be removed within 25-54 days of their implantation

 

Report

Time-out akkoord. Toegang via de vena femoralis. Cavogram toont geen thrombus in het filter. Snaren van het filter, en retrieval door de sheath over het filter te schuiven. Toegang gesloten met manuele compressie.

 

Literature

File NameTypePermissionsChanged DateDateSize

  1. J. Mark Ryan, MD, S. M. Key, Siobhan A. Dumbleton, MD, and Tony P. Smith, MD Nonlocalized Lower Gastrointestinal Bleeding: Provocative Bleeding Studies with Intraarterial tPA, Heparin, and Tolazoline J Vasc Interv Radiol 2001 Nov;12(11):1273-7

  2. Baum ST. Arteriographic diagnosis and treatment of gastrointestinal bleeding. In Baum ST, Pentecost MJ, eds. Abrams' angiography interventional radiology. 2nd ed. Philadelphia, Pa:Lippincott, Williams & Wilkins, 2006:488.

  4. Poultsides GA, Kim CJ, Orlando R 3rd, et al. Angiographic embolization for gastroduodenal hemorrhage: safety, efficacy, and predictors of outcome. Arch Surg. 2008;143:457-461.

  5. Eriksson LG, Sundbom M, Gustavsson S, Nyman R. Endoscopic marking with a metallic clip facilitates transcatheter arterial embolization in upper peptic ulcer bleeding. J Vasc Interv Radiol. 2006;17:959-964.

  6. Dixon S, Chan V, Shrivastava V et al. Is there a role for empiric gastroduodenal artery embolization in the management of patients with active upper GI hemorrhage? Cardiovasc Intervent Radiol. 2013 Aug;36(4):970-7.

  7. Shin JH. Recent update of embolization of upper gastrointestinal tract bleeding. Korean J Radiol 2012;13 Suppl 1:S31-S39.

  9. van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2008;22(2):209-24.

  10. Sildiroglu O, Muasher J, Arslan B, Sabri SS, Saad WE, Angle JF, Matsumoto AH, Turba UC. Outcomes of patients with acute upper gastrointestinal nonvariceal hemorrhage referred to interventional radiology for potential embolotherapy. J Clin Gastroenterol. 2014;48(8):687-92.

  11. Strate LL, Gralnek IM. ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding. Am J Gastroenterol. 2016 Apr;111(4):459-74.

  13. van Dam J, Brugge WR. Endoscopy of the upper gastrointestinal tract. N Engl J Med. 1999;341(23):1738-48.

  15. Lefkovitz Z, Cappell MS, Lookstein R, Mitty HA, Gerard PS. Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia. Med Clin North Am. 2002 Nov;86(6):1357-99.

  16. Lee EW, Laberge JM. Differential diagnosis of gastrointestinal bleeding. Tech Vasc Interv Radiol 2004; 7: 112-22

  18. Strate LL, Gralnek IM. ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding. Am J Gastroenterol. 2016 Apr;111(4):459-74.

  19. Chaudhry V, Hyser MJ, Gracias VH, Gau FC. Colonoscopy: the initial test for acute lower gastrointestinal bleeding. Am Surg. 1998 Aug;64(8):723-8.

  20. Cummings CL. Value of early capsular endoscopy for severe gastrointestinal bleeding. J Natl Med Assoc. 2004;96(12):1653-6.

  21. Appleyard M, Glukhovsky A, Swain P. Wireless-capsule diagnostic endoscopy for recurrent small-bowel bleeding. N Engl J Med. 2001;344(3):232-3.

  24. Lim JK, Ahmed A. Endoscopic approach to the treatment of gastrointestinal bleeding. Tech Vasc Interv Radiol. 2004 Sep;7(3):123-9.

  25. Nicholson AA, Ettles DF, Hartley JE, et al. Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage. Gut 1998; 43:79–84.

  26. Zuckier LS. Acute gastrointestinal bleeding. Semin Nucl Med. 2003 Oct;33(4):297-311.

  27. Imbembo AL, Diverticular disease of the colon. In: Sabiston D, Editor. Textbook of Surgery (14th edn). Philadelphia, PA:WB Saunders, 1992:910.

  29. Loffroy R, Rao P, Ota S, De Lin M, Kwak BK, Geschwind JF. Embolization of acute nonvariceal upper gastrointestinal hemorrhage resistant to endoscopic treatment: results and predictors of recurrent bleeding. Cardiovasc Intervent Radiol. 2010 Dec;33(6):1088-100. doi: 10.1007/s00270-010-9829-7. Epub 2010 Mar 16.

  31. Eriksson LG, Sundbom M, Gustavsson S, Nyman R. Endoscopic marking with a metallic clip facilitates transcatheter arterial embolization in upper peptic ulcer bleeding. J Vasc Interv Radiol. 2006 Jun;17(6):959-64.

  32. Anthony S, Milburn S, Uberoi R. Multi-detector CT: review of its use in acute GI haemorrhage. Clin Radiol. 2007 Oct;62(10):938-49.

  33. Ernst O, Bulois P, Saint-Drenant S, Leroy C, Paris JC, Sergent G. Helical CT in acute lower gastrointestinal bleeding. Eur Radiol. 2003;13(1):114-7

  34. Mirsadraee S, Tirukonda P, Nicholson A, Everett SM, McPherson SJ. Embolization for non-variceal upper gastrointestinal tract haemorrhage: a systematic review. Clin Radiol 2011;66:500-509.

  35. Loffroy R, Guiu B, D'Athis P, Mezzetta L, Gagnaire A, Jouve JL, Ortega-Deballon P, Cheynel N, Cercueil JP, Krausé D. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009 May;7(5):515-23.

  36. Aina R, Oliva VL, Therasse E, et al. Arterial embolotherapy for upper gastrointestinal hemorrhage: outcome assessment. J Vasc Interv Radiol 2001;12:195-200.

  37. Mirsadraee S, Tirukonda P, Nicholson A, Everett SM, McPherson SJ. Embolization for non-variceal upper gastrointestinal tract haemorrhage: a systematic review. Clin Radiol 2011;66:500-509.

  38. Loffroy R, Guiu B, Cercueil JP, Lepage C, Latournerie M, Hillon P, Rat P, Ricolfi F, Krausé D. Refractory bleeding from gastroduodenal ulcers: arterial embolization in high-operative-risk patients. J Clin Gastroenterol. 2008 Apr;42(4):361-7.

  39. Loffroy R, Guiu B, D'Athis P, Mezzetta L, Gagnaire A, Jouve JL, Ortega-Deballon P, Cheynel N, Cercueil JP, Krausé D. Arterial embolotherapy for endoscopically unmanageable acute gastroduodenal hemorrhage: predictors of early rebleeding. Clin Gastroenterol Hepatol. 2009 May;7(5):515-23.

  40. Poultsides GA, Kim CJ, Orlando R 3rd, Peros G, Hallisey MJ, Vignati PV. Angiographic embolization for gastroduodenal hemorrhage: safety, efficacy, and predictors of outcome. Arch Surg 2008;143:457-461.

  42. Gordon RL, Ahl KL, Kerlan RK, Wilson MW, LaBerge JM, Sandhu JS, Ring EJ, Welton ML. Selective arterial embolization for the control of lower gastrointestinal bleeding. Am J Surg. 1997;174(1):24-8.

  43. Funaki B, Kostelic JK, Lorenz J, Ha TV, Yip DL, Rosenblum JD, et al. Superselective microcoil embolization of colonic hemorrhage. AJR Am J Roentgenol 2001;177:829-836 7.

  44. Bandi R, Shetty PC, Sharma RP, Burke TH, Burke MW, Kastan D. Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 2001;12:1399-1405.

  45. Maleux G, Roeflaer F, Heye S, Vandersmissen J, Vliegen AS, Demedts I, et al. Long-term outcome of transcatheter embolotherapy for acute lower gastrointestinal hemorrhage. Am J Gastroenterol 2009;104:2042-2046

  46. Leitman IM, Paull DE, Shires GT 3rd. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg 1989;209:175-180

  47. Rosenkrantz H, Bookstein JJ, Rosen RJ, Goff WB 2nd, Healy JF. Postembolic colonic infarction. Radiology 1982;142:47-51.

  48. Koh DC, Luchtefeld MA, Kim DG, Knox MF, Fedeson BC, Vanerp JS, et al. Efficacy of transarterial embolization as definitive treatment in lower gastrointestinal bleeding. Colorectal Dis 2009;11:53-59

  49. Lipof T, Sardella WV, Bartus CM, Johnson KH, Vignati PV, Cohen JL. The efficacy and durability of super-selective embolization in the treatment of lower gastrointestinal bleeding. Dis Colon Rectum 2008;51:301-305

DISCLAIMER

The information contained herein has been obtained from sources believed to be reliable. However, no warranty as to the accuracy, completeness or adequacy of such information is implied. No liability is accepted for errors, omissions or inadequacies in the information contained herein or for interpretations thereof. The reader assumes sole responsibility for the selection of these materials to achieve its intended results. The opinions expressed herein are subject to change without notice.

Thank you! ×
Opps! Some went wrong... Your submission did not go through :-(×
Stacks Image 14

WEBDESIGN

Stacks Image 20

PHOTOGRAPHY

Stacks Image 26

E-COMMERCE

Stacks Image 32

SEO

Stacks Image 38

COLORS

Stacks Image 44

CRM

EXCELLENCE IS NOT A SKILL, IT'S AN ATTITTUDE

WEBDESIGN - PHOTOGRAPHY - GRAVENDEEL