If you have had a deep vein thrombosis (DVT), you may worry about having another life-threatening clot. People who’ve had a DVT and can’t take blood thinning medications have another option to prevent recurring clots with pulmonary embolism (PE). This is surgical placement of an inferior vena cava filter.
An inferior vena cava filter is a small device placed inside a vein called the inferior vena cava. A doctor uses a thin catheter that is inserted into your neck or groin to put the filter in place. This device can stop DVT clots from moving through the inferior vena cava into your lung, where they can cause a pulmonary embolism. PEs can be very serious, leading to pain, severe shortness of breath, or even death. IVC filters can help prevent PEs and save your life.
What Is an IVC Filter?
An IVC filter is a small, umbrella-shaped metal device. It catches and traps larger blood clots as they move up your inferior vena cava from your legs or pelvis. This filter keeps the clots from breaking apart, flowing through the vein, and moving into your lungs or heart.
Before now, IVC filters were only placed in your vein and left there permanently. Now there are removal filters that can be put in and then taken out later on. They’re called optionally retrievable filters. If your doctor thinks you’re no longer at high risk for DVT or PE that happens again, they may be able to go back in and remove the filter. It’s best to remove it within 6 months of your placement procedure.
Who Can Get an IVC Filter?
Doctors place IVC filters in people who have had DVT episodes or are at higher risk to develop future blood clots in their legs.
An IVC filter may be right for you if you can’t take blood-thinning medication or it doesn’t work for you and you:
- Have a diagnosis of DVT or pulmonary embolism
- Have had a physical trauma or accident
- Are unable to move
- Are at risk for another clot
Many health conditions can raise your risk of blood clots because they slow down the normal blood flow through your veins:
- Recent surgery or injuries, especially if you can’t move around afterward or if they cause inflammation
- Deep vein injury in your leg
- Blood diseases that increase clotting
- Long airplane trips where you don’t move for hours
- Cancer treatments
- Older age
In some cases, your doctor may prescribe a blood thinner medicine like warfarin to prevent clots along with your IVC filter. But if you've recently had surgery, an injury that causes internal bleeding, a hemorrhagic (bleeding) stroke, or bleeding in your intestines, taking a blood thinner could be dangerous or life-threatening. Then an IVC filter alone would be used to prevent clots.
What Are the Pros and Cons of IVC Filter Placement?
IVC filter placement is done with a short procedure. Your doctor or radiologist only needs to make a small nick in a vein. As with any surgery, there’s a very slight risk of infection where you have the incision. If they use contrast dye to guide the procedure on an X-ray, there’s also a very slight risk of a reaction to the dye.
There are some other rare risks that are possible with this surgery:
- Vein damage or puncture during the procedure
- Infection in the vein
- The IVC filter moves, goes through the walls of the vein, and causes an internal injury, or breaks apart and travels to your heart and lungs, causing a life-threatening PE
- Very rarely, the IVC filter becomes clogged with blood clots, causing your legs to swell
Even if you have an IVC filter placed, you can still get a blood clot down the road. Even if you do have another DVT, this filter helps to lower your risk of a pulmonary embolism and could save your life.
To be sure IVC filter placement is the right choice and safe for you, you’ll see your doctor for a consultation and exam. They’ll test your blood to check how it forms clots. They’ll also test your kidney function. Let your doctor know about any recent illnesses or medical problems.
If you’re pregnant or think you may be pregnant, let your doctor know. X-rays used during IVC filter placement could harm the baby, so they’ll need to take steps to protect your baby from radiation.
How Is IVC Filter Placement Surgery Done?
It’s a minimally invasive procedure that takes about one hour. A specialist called an interventional radiologist may do your surgery.
You’ll have this surgery as an outpatient procedure in the operating room or interventional radiology center at the hospital.
Usually, you can go home right afterward, but your doctor may ask you to stay overnight if needed. If you can go home on the day of your filter placement, you’ll need to arrange to have someone drive you there and back.
How Will You Prepare for Your Surgery?
Tell your doctor about all the medications, herbs, and supplements you take for any reason. This includes OTC medicines, vitamins, or supplements. Your doctor may tell you to stop taking some medications temporarily before your IVC filter placement. This includes any blood thinners, nonsteroidal anti-inflammatory drugs (NSAIDs), and aspirin.
Also, let your doctor know if you think you’re allergic to either anesthesia medicine or contrast dyes that may be used during this surgery.
If you’re diabetic and take insulin, your doctor will tell you exactly how to change what you eat and how to adjust when you take insulin on the day of your procedure.
Smoking tobacco can slow down healing after any surgery. If you smoke, you need to stop before you have this procedure. Talk with your doctor if you need help to quit smoking.
What Happens During the Surgery?
To place the filter in your inferior vena cava, your surgeon will make a small incision into a vein, either in your neck or groin area. They’ll insert a catheter with the filter on the end inside the vein. While it’s being placed, the IVC filter is collapsed and flat.
The catheter is a long, flexible tube that’s about one-eighth of an inch thick. They’ll inject a dye in your vein that shows up on either X-ray or ultrasound images to guide the placement of the filter. These images are shown on monitors in the operating room, so your doctor can watch them and make sure your IVC filter is placed in exactly the right spot.
Your doctor will gently move the catheter through your vein to put the IVC filter in the correct spot to block blood clots. Once it’s in place, your doctor will detach the IVC filter from the catheter. Once they remove the catheter, the collapsed IVC filter expands so it can fit snugly inside the walls of this blood vessel and work properly.
Once the IVC filter is in the right spot and expanded, your doctor will remove the catheter tube. They’ll apply pressure on the incision to stop any bleeding. They may seal up this spot, so you can move around after the procedure and when you go home afterward. The nurse will place a sterile bandage over your skin so it stays clean. You won’t see any stitches on your skin.
What Happens After IVC Filter Placement Surgery?
You’ll need to spend a few hours resting in the recovery room after the procedure.
Your nurse will watch you closely to make sure your heart rate and breathing are normal. They can give you pain medicine if you need it. You may have a headache or nausea. These should go away quickly.
Once you’re fully awake, you can slowly stand up and get dressed to go home. Rest up for a day after your procedure.
- If your IVC filter was placed through a vein in your neck, you can go back to your normal activities 24 hours later.
- If your IVC filter was placed through a vein in your groin, your doctor will likely tell you not to drive for at least 24 hours and not to lift heavy objects for at least 48 hours. They’ll give you details about what activities are safe for you to do.
During the days after your IVC filter placement, you may have some pain at the incision site or notice some bruises. Your doctor will tell you what pain medicine is safe to take if you need it. They’ll also give you instructions for how to care for your incision area.
Call your doctor immediately if you notice any of these signs after your surgery:
- One of your limbs feels cold or numb.
- The incision site bleeds and won’t stop when you apply pressure.
- The incision site swells or feels very painful and doesn’t stop, or leaks fluid, feels warm, or appears red.
- You have a fever, chest pain, or shortness of breath.
- You have headaches or nausea that don’t let up or go away.
You may also need to schedule a follow-up visit for a physical exam, some imaging tests of the IVC filter in place, and blood tests. Later on, you may need X-rays to make sure your IVC filter is still in the right place and hasn’t moved.
Complications After IVC Filter Placement
It’s rare, but some people who have IVC filter placement surgery can have complications, like bleeding or infection at the incision site, allergic reactions to X-ray contrast dye, or a pulmonary embolism.
Will I Have My IVC Filter Removed at Some Point?
Some people who have an IVC filter placed can have it removed later. The procedure is much like the one you had to place the device. They insert a catheter to remove it.
If your risk of pulmonary embolism passes in the future, you might be able to have the IVC filter device taken out. It may also be safe to remove the filter if you are able to take blood thinners safely again. In some cases, a retrievable IVC filter device can be removed even years later.
You may need to leave an IVC filter in for good to prevent pulmonary embolism. That may be the case if
you remain at risk for pulmonary embolism and still can’t take a blood thinner. Your doctor may also not be able to take it out if scar tissue forms around the device or if it becomes embedded in the walls of your vein.