Vena Cava Filter Placement

Using fluoroscopy image-guidance (a form of X-ray imaging that allows doctors to see motion in real time), a catheter is placed in a blood vessel in the groin or neck. Through the catheter, a filter is placed into the Inferior Vena Cava where it will attach to the walls of the blood vessel and trap any life-threatening blood clots that could travel to the lungs.

When you arrive for your procedure a nurse will greet you and let the team know you’ve arrived. You will be brought into an exam room and asked to change into a gown. Your doctor will greet you, explain the procedure and answer any questions you may have.

You will lie on an exam table for the procedure. The technologist or nurse will connect monitors for your heart rate, blood pressure, and pulse, and an intravenous (IV) line will be inserted into a vein in your hand or arm. This will be used to give you sedatives during the procedure.

The technologist will shave, sterilize, and cover the area of your body where a catheter will be inserted (usually either your neck or groin) with a surgical drape. The area will then be numbed using a local anesthetic. You may feel a tiny pinch when the anesthesia is administered. The doctor will make a very small nick in your skin, and you may feel some pressure as the catheter is inserted, but you won’t feel any serious discomfort. Using image-guidance, the catheter will be directed to the vein. You may feel some additional pressure as the catheter is put in place.

Contrast material (also called X-ray dye) is then injected to guide the catheter and place the filter into the inferior vena cava. You may feel a warm sensation when the contrast material is injected. Once the filter is in place, the catheter will be removed and pressure will be applied to the wound to stop any bleeding. You will not require any stitches. Your IV line will be removed and you will be taken to a recovery area to rest. The procedure can usually be completed within one hour.

Once you have recovered and feel ready you will be able to go home. You may feel some swelling or discomfort at the site where the catheter was inserted but this can usually be resolved with over-the-counter pain medication. Please discuss this with your doctor.

Your doctor will discuss with you any limitations to your daily activity following the procedure.

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. You might like to keep a list of questions or — as you’re doing now — educate yourself about the procedure.

Some other things to keep in mind in planning for this procedure include:

• You should plan to have someone take you home after the procedure as you will not be able to drive after sedation.
• You will need to get blood tests to check your liver and kidney function.
• Your doctor may also request an EKG.
• Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or blood thinners (such as Coumadin or warfarin) for a time before the procedure.
• Five days before the procedure, stop taking vitamin E.
• The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a nurse from the Interventional Radiology.
• Department will call you. The nurse will give you any additional instructions, and will ask if you have any questions.
• In the 8 hours before the procedure, do not eat food.
• Up to 2 hours before you arrive at the hospital, you may drink clear liquids. Black coffee or tea are fine, but do not add cream or milk. You may sip water with medications.
• When you arrive, make sure the nurse and radiologist know about any allergies you may have, especially allergies to local anesthetics (such as lidocaine), general anesthetics (such as propofol), or X-ray dye (contrast media). If there’s any chance you may be pregnant, tell your radiologist.

On the day of your procedure you should:

• Wear comfortable, loose-fitting clothes
• Wear comfortable shoes
• Avoid bringing jewelry or valuables

The benefits of a filter placement may include:

• Prevention of life-threatening blood clots traveling to your lungs without the use of blood-thinning medication.
• This is a minimally invasive procedure that does not require stitches. Most patients can resume normal activities within a day or two.

Some risks that you should be aware of include:

• As with any procedure that involves a catheter placed inside a blood vessel there is potential for damage to the blood vessel, bruising or bleeding at the puncture site, and infection.
• Slight risk of allergic reaction to the contrast material used.
• There is a risk that the filter can implant in the wrong place or become dislodged and cause damage to nearby organs or travel to the heart or lungs causing injury or death.
• There is a very rare chance that the filter will catch too many clots and block blood flow in the blood vessel.
• There is a chance that the filter will not be able to be retrieved/removed.

Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.