What are the risks of an IVC filter?

baird IVC filter risk

One of the services we offer our patients is IV filter placements. Inferior vena cava (IVC) filters are small metal devices placed in patients at risk of developing blood clots or deep vein thrombosis in the legs or pelvis; the clots can break off and cause pulmonary embolism, the lodging of an embolus, such as a blood clot, in the lungs. Your doctor may recommend an IVC filter for conditions such as deep vein thrombosis (DVT), pulmonary embolism, trauma immobility or recent surgery or childbirth.

Recently, IVC filters have been a topic of conversation on whether they’re safe or not. We talked to Dr. Brian Strife about IVC filters and here’s what he had to say.

“IVC filters have been placed for the last several decades, developed initially in the 1960’s,” he said. “Originally, they were designed as permanent devices, meaning the filter would be placed in the patient’s vein, and it was designed to remain in place for the life of the patient.”

In the last few years, retrievable filters were developed. They have a hook or some other component to the filter where a physician could grab it and remove it. “Over time, what we learned is that some of these filters were prone to develop problems in a very small number of them,” said Dr. Strife. “The problems included migration, or movement of the filter, fracture or breaking of the filter, and then clotting of the filter.” Those are the 3 main complications that we often hear about with inferior vena cava filters.

“When the filter itself develops a blood clot,” he continued, “it can block the main vein, the IVC, this can lead to significant pain and swelling in the lower extremities. Also, the filters themselves, being made out of metal, over time the metal can stress and fatigue. The filter can break, pieces of the filter can migrate into the patient and damage adjacent organs. Very rarely, pieces of the filter can break off and go to the heart and lungs.”

The filters, whether they are permanent or retrievable types, are meant to stay in the patient for a long time. The filters are made out of stainless steel or some kind of metal alloy that is designed to withstand years of being inside a human body. It’s a rare occurrence that the filters have any problems at all.

“Although these complications are extremely uncommon,” said Dr. Strife. “It is a source of patient anxiety and we often receive a number of phone calls from patients asking if they should have their filter removed to avoid these complications.”

“In 2010, the FDA recommended that physicians who placed these filters, and physicians who follow patients with these filters, make an attempted to consider IVC filter retrieval when the filter is no longer needed,” he continued. “Sometimes that’s a tough question to answer, because we don’t necessarily know which patients are best suited to have a filter in for the rest of their lives. When a patient calls our office and says ‘I have an inferior vena cava filter and I’d like to have it removed,’ we typically have the patient come in for a consultation, discuss why they have the filter in the first place, and try to make an informed decision on whether retrieval is appropriate for them or not. Sometimes, that’s a very easy question to answer, sometimes we need to do additional tests and consult with other physicians before making that decision.”

If you need an IVC filter, our would like to talk to us about one you currently have, call us at (804) 828-2600 to discuss your options.

I’ve had an IVC filter for a long time, should I be concerned?

Baird IVC Filter

Inferior vena cava filters, or IVC filters, whether they are permanent or retrievable types, are designed to be left in the body for a long time. They are made from stainless steel or a metal alloy and are designed to withstand years of placement within a human body.

“Occasionally, though, those filters can have problems,” said Dr. Brian Strife, at VCU Health’s Baird Vascular Institute. “The three main problems we see are the filter itself developing blood clots and blocking the main vein, the IVC, which can result in swelling and extreme pain in the lower extremities. Also, the metal itself in the filter can stress or fatigue, causing the filter to break, and pieces of the filter can migrate into the patient and damage adjacent organs, and very rarely, pieces of the filter can break and go into the heart and lungs.”

These types of issues are extremely uncommon, assures Dr. Strife. “We do know these issues are sometimes a cause of patient concern and anxiety, and we often receive calls from patients asking whether or not their filter needs to be removed to avoid these complications.”

“In 2010, the FDA recommended that physicians who placed these filters and physicians who treated patients with the filters make an attempt to consider filter retrieval when that filter is no longer needed,” Dr. Strife continued. “Sometimes that’s a tough call,” he said, “because we don’t necessarily know which patients are best suited to have an IVC filter in for the rest of their life.”

When a patient calls our office with an IVC filter they would like to have removed, we first have that patient come in for a consultation to discuss why they had the filter in the first place, then we will make a decision on whether retrieval is appropriate for them or not. “Sometimes that’s an easy decision to make,” said Dr. Strife, “and sometimes we need to run further tests and consult with other physicians before making that decision.”

If you would like to discuss concerns or problems you may be experiencing or if your doctor has recommended that you see us for a vascular test, please contact us at (804) 828-2600 or email us.

 

I’ve been told I need dialysis. What can VCU Health at Baird Vascular Institute do for me?

At the VCU Health at Baird Vascular Institute, our experts are uniquely equipped to deal with the maintenance and care of your dialysis access in a convenient, neighborhood setting. With the latest technology and highly skilled staff, each case is approached as a unique and individual patient, complete with plans of care and follow-up.

If you are starting hemodialysis treatments in the next several months, one crucial step before starting regular hemodialysis sessions is preparing a site on the body to access the vein. Dialysis access is the site on your body where blood is removed and returned during dialysis. To maximize the amount of blood cleansed during hemodialysis treatments, dialysis access should allow continuous high volumes of blood flow.

There are three access options for the dialysis patient – AV fistula, AV graft or a central venous catheter.

To allow for the high volume of blood exchanged, dialysis access to your blood is usually in your arm or leg. Choosing your access is a decision that you and your doctor will make.

Here is some additional information about your options.

AV Fistula

An AV (arteriovenous) fistula is a surgical connection of one of your own arteries to a vein under the skin of your arm. It’s the most natural dialysis access because it’s made with your own blood vessels. Most people can tolerate an AV fistula. However, if your veins are too small or too weak for a fistula, there are other options.

An AV fistula requires advance planning because the fistula takes a while to develop, or mature, after surgery, — in rare cases, as long as 24 months. However, a properly formed fistula is less likely than other kinds of vascular access to form clots or become infected. Also, properly formed AV fistulas tend to last many years—longer than any other type of dialysis access.

AV Graft

An AV graft is a surgical insertion of a special tube that connects to a vein and an artery. It becomes an artificial vein and is used like a fistula. If you have small blood vessels that won’t develop into a fistula, an AV graft may be a good option for you.

An AV graft doesn’t need time to mature as a fistula does, so it can be used sooner after its placement, often within 2 or 3 weeks. Compared with properly formed AV fistulas, AV grafts tend to have more problems with clotting and infection, and need replacement sooner. However, a well-cared-for AV graft can last several years.

Central Venous Catheter

If your kidney disease has progressed quickly, you may not have time to get a permanent dialysis access before you start hemodialysis treatments. You may need to use a central venous catheter as a temporary access. A catheter is a tube inserted into a vein in your neck, chest, or leg near the groin.

Central venous catheters are not ideal for permanent access. They can clog, become infected, and cause narrowing of the veins in which they are placed. But if you need to start hemodialysis immediately, a central venous catheter will work for several weeks or months while your permanent access develops.

For some people, AV fistulas or AV grafts are unsuccessful and they need to use long-term catheter access. Central venous catheters that will be needed for more than about 3 weeks are tunneled under the skin to increase comfort and reduce complications. However, even tunneled catheters are more prone to infection than AV fistula and AV grafts.

Your healthcare team will help you choose the best long-term dialysis access for your situation. If you already have an AV fistula/AV graft that is not functioning properly, or if you need a central venous catheter, speak with your doctor and contact us. We can diagnose and treat you to get your access functioning. Please contact us at (804) 828-2600 or email us at bairdvascularinstitute@mcvh-vcu.edu.

What is an IVC Filter and how is it placed?

Inferior vena cava (IVC) filters are devices placed in patients who have a history or risk of developing DVT’s or blood clots in the legs or pelvis that may develop into pulmonary emboli, or a blood clot in the lungs. Your physician may recommend an IVC filter for the following conditions:

  • Deep vein thrombosis (DVT)
  • Pulmonary embolus
  • Trauma victims
  • Immobility
  • Recent surgery or childbirth

Using image guidance, an IVC filter is inserted via a blood vessel. Typically, the vein in the groin, or the jugular vein in the neck is used. The IVC filter is then placed through the catheter and into the vein. Once it is in the correct position, the interventional radiologist will release the filter, allowing it to fully expand and attach itself to the walls of the blood vessel.

At the end of the procedure, the catheter will be removed and pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed. Your intravenous line will then be removed to complete the procedure.

The procedure is usually completed within one hour.

 

Source: www.radiologyinfo.org