Inferior Vena Cava Filters

Authors: Dr Stuart Lyon*
                            Dr James Burnes *

What are the prerequisites for having an inferior vena cava filter done?

Essentially high risk of pulmonary embolism or severe consequences of pulmonary embolism. These include:

• iliofemoral DVT;
• large pulmonary embolus;
• poor pulmonary or cardiac reserve with PE or DVT;
• DVT or PE;
• contraindication to anticoagulation.

Prophylactic indications include previous PE’s with surgery and trauma where the patient is at high risk of DVT.

What are the absolute contraindications for an inferior vena cava filter?

There are no absolute contraindications for an IVCF.

What are the relative contraindications for an inferior vena cava filter?

• Allergy to iodinated contrast;
• no central venous access;
• renal failure; and
• pregnancy.

What are the adverse effects of an inferior vena cava filter?

Complications are uncommon but include:

• Acute: pneumothorax (less than 1%), haemothorax, allergic reaction to contrast media, retroperitoneal haematoma.
• Longer term: filter migration (0-18%), filter perforation (0-41%), filter fragmentation and embolization (2-10%), caval thrombosis, recurrent DVT, varicose veins, leg pain, venous ulceration, filter infection (very rare).
• Filters may result in blockage of the vein (inferior vena cava, 2-30%) either as a result of the filter having been in there for a very long time or if the filter captures very big clots. Most of the time you would not notice this. Occasionally this may result in higher rates of blood clots in the legs, varicose veins, leg pain or ulceration (2-15%).

Are there alternative imaging tests, interventions or surgical procedures to an inferior vena cava filter?

The main management for DVT and PE is medical, however, once the indications for IVC filter have been reached the only alternatives are now historical.

*The author has no conflict of interest with this topic.

Page last modified on 26/7/2017.