IVC Filter Implantation

What is an Inferior Vena cava (IVC) Implantation?

This is a minimally invasive medical procedure. During the procedure, your vascular surgeon inserts an IVC filter into your inferior vena cava.

The aim is to trap blood clots from moving into your lungs. Such blood clots cause blockage or pulmonary embolism (PE).

PE is occasioned by a blood clot that has traveled from another part of your body, usually the leg, to your lungs. This clot blocks your pulmonary artery, thereby restricting blood flow to the lungs.

Some patients with excessive bleeding cannot take anticoagulants. For such patients, an IVC filter is recommended.

Those with blood clots will also benefit from IVC implantation. An IVC transports oxygen-deficit blood from your lower body to the heart. From here, blood is pumped to your lungs for oxygenation.

Inserting a filter in your IVC allows for the passage of blood through it. The filter retains any clots in your blood effectively ensuring they do not travel to your lungs or heart.

An IVC filter prevents a PE. During an IVC implantation, the surgeon makes a small incision on your neck or groin.

The incision allows your surgeon to place the IVC filter. The surgeon attaches an IVC filter to a catheter and moves it into the vein where it attaches to the IIVC wall and expands.

Deep vein thrombosis (DVT)

DVT or deep vein thrombosis is a serious health condition whereby a blood clot occurs in a deep vein, primarily the leg vein.

In case such a clot finds its way to the heart or lungs, it can be fatal.

Anticoagulants or blood-thinning medication remains the standard treatment for DVT.

Wearing compression stockings has also been shown to assist with treating the condition. If both of these treatments are accompanied by complications, an IVC filter becomes the safest treatment for DVT.

Pulmonary Embolism (PE)

PE is a condition that is characterized by the sudden blockage of one or more of your arteries that transport blood from the heart to the lungs.

A PE occurs after a blood clot detaches from a deep vein in the leg and travels to your lungs.

Anticoagulants are the primary medication for preventing PE but in case of contraindications for such medication, your surgeon may recommend IVC filters.

What is an IVC filter?  

This is a filtering device usually placed within the IVC to trap large blood clots and avoid their dislodging on the lungs or heart. 

IVC filters are ideal for patients for whom blood thinners and other conventional medical therapies may not work. 

IVC filters minimize the risk of PE. While an IVC filter may not guarantee avoiding deep vein thrombosis (DVT) it protects patients with a DVT from PE which can be life-threatening. 

IVC filters can be either permanent or retrievable. Permanent IVC filters are ideal for individuals with medical issues and for whom blood thinning medication cannot work.

These are the people who are less likely to develop medical complications after taking blood-thinning medication. Retrievable or optional filters work best for those with a limited risk of blood clots.

Who needs an IVC filter implantation?

People with venous thromboembolism (VTE) due to blood clots in the veins may require an IVC filter. You will also need an IVC filter if:

Blood thinning medication does not work for you, owing to a negative reaction or excessive bleeding. If you have PE or are highly prone to a recurrence, your surgeon will not recommend blood thinning medication.

The following conditions may also predispose you to VTE:

• Pregnancy

• In case of surgery or trauma-induced immobilization

The following conditions put you at risk of a DVT:

• Individuals who have recently undergone surgery which might increase inflammation and limit mobility, thus resulting in clotting

• An injury or stroke that decreases your mobility

• Individuals who have sustained a deep vein injury in the leg

• People undergoing cancer treatment

• Smoking

• Age – Older patients are more prone to DVT

• Blood disorders like sickle cell anemia which are Inherited

If your healthcare provider identifies you to be at risk of PE, he/she may recommend warfarin or other medication blood thinning medication.

For some patients, blood thinner alone can avoid PE. For other patients, it may be necessary to incorporate the IVC filter as well.

If blood thinning medication does not work, this might trigger excessive bleeding.

Your healthcare provider will recommend an IVC filter only to avoid life-threatening complications of blood thinners.

Types of IVC filters

There are two types of IVC filters in use by healthcare providers:

Inferior vena cava (IVC) filter

This is by far the most common filter in use by healthcare providers. It restricts blood clots from the upper body.

Superior vena cava (SVC) filter

An SVC filter ensures blood clots o not travel to your upper body.

Preparing for an IVC Filter Implantation

In the days ahead of an IVC filter placement, you will have received guidance from your health provider on what to expect.

If you are on blood thinners of nonsteroidal anti-inflammatory drugs (NSAID), your provider will advise you on when to stop taking them.

Patients are also advised not to drink or eat anything for a specified number of hours before the procedure.

If you are taking insulin or are diabetic, your providers will give detailed instructions on insulin dose and diet. This may necessitate adjusting the normal insulin dose.

Before surgery, your provider may also order the following tests:

• HIV, HBsAg, HCV serology

• Ultrasound (abdomen)

• Prothrombin time (PT)

• Complete Blood picture

• Ultrasound (leg veins)

• Renal function tests (this includes creatinine and blood urea nitrogen)

• Partial Internal normalized ratio (INR)

• Echocardiogram

• Electrocardiogram

With an IVC filter implantation, you will rarely need magnetic resonance (MR) or computed tomography (CT) tests.

Make sure to fully engage your healthcare provider and understand the procedure fully, and what it entails. Ask all the relevant questions that you might have to better understand the procedure.

Ask your provider whether you have a permanent IVC filter or a temporary one. Your healthcare provider will ask you to sign a consent form before the surgery.

Make sure you have read through his form in its entirety. If you have any questions, make sure they are fully answered before signing the form.

If you are on any medication, let your healthcare provider know of this.  If you are taking any supplements or vitamins, let your provider know of this as well.

Smokers are advised to stop the habit before the procedure as it might delay healing.

Your healthcare provider will assist you with advice on how to stop smoking.

Disclose the following information to your provider before surgery:

• In case you are pregnant

• If you are allergic to any medication

• In case you develop a negative reaction to sedation

• In case you have recently developed a fever or any other changes in health

During the procedure

An IVC filter placement is a short medical procedure that takes about one hour. The medical team administering this procedure consists of specialized nurses and an interventional radiologist.

During the procedure, the surgical team starts by sedating you. The sedative is inserted into a vein in your arm or hand via an IV.

In case of any hair on your skin, the surgical team will first shave it. The surgical team cleans the skin using an antiseptic solution.

A catheter helps to administer local anesthesia. The surgical team places a catheter through small incisions around your groin or neck region.

Your surgeon guides the catheter via your IVC with the help of a fluoroscopy. The surgeon may also opt to administer an X-ray dye via the catheter to act as a contrast material. This allows them to have a better view of the IVC.

The next step is to insert the IVC filter on the IVC. Once the IVC filter is in place it expands and firms attaches to the walls of your IVC.

The surgical team removed the catheter along with the IV. Your surgeon will close the incision and seal it with a bandage.

You will remain in the recovery room for a few hours after surgery. The surgical team will closely monitor your breathing, heart rate, and other vital signs.

When you regain consciousness you are likely to feel confused and sleepy which is normal after sedation.

You could also feel nauseated or have a headache but this does not last long. Most people get discharged from hospital on the same day of the procedure, barring any complications.

It is advisable to have a spouse, family member or friend accompany you to surgery so that they can drive you back home.

Some healthcare facilities also make travel arrangements for their clients to and from the procedure. Check with your healthcare provider to see if they offer such services.

You are likely to feel pain post-surgery as the sedation wears off. You could also have suffered a bruise at the point of inserting the catheter. For this kind of pain, over-the-counter medication will do.

Make sure you are fully rested after an IVC filter implantation. Do not partake in any physical activities that will put you have you straining for the next 24-48 hours.

Watch out for the following signs and contact your healthcare provider immediately:

• If one or both of your limbs feel numb or cold

• If the site of the incision is painful or swollen even after taking medication and seems to exacerbate

• If the site of the incision starts bleeding and such bleeding does not cease even after applying pressure to it

• In case the incision site has fluid leaking

• If you have developed a fever

• In case the incision site feels warm or develops a redness to it

• Nausea and headache that does not subside with time

• In case you develop chest discomfort or pain

• Make sure that you have fully adhered to all the instructions and advice from your surgeon, including advice about wound care, medication, rest, and exercise

Your surgeon can recommend warfarin or other types of anticoagulants to avoid blood clots.

Post-surgery assessment

You will be subjected to ongoing monitoring by the surgical team to ensure the surgery went well and that you are making good progress in your path to recovery.

Your surgeon will recommend follow-up imaging tests to ensure the filter is firmly in place. 

In the case of a removable IVC filter, this will be removed once the surgeon has ascertained your reduced risk for DVT. 

Benefits of IVC filters

• IVC filter implantation is a minimally invasive procedure

• Only a small incision is needed to insert the IVC

• Faster recovery

• The success rate of the IVC filter is quite high in protecting patients from PE

Risks/Complications

While IVC filter placement is largely considered a safe procedure, the following risks might accompany challenges that may be encountered during the procedure:

• Congenital malformation – Such congenital malformations as a duplicated left vena cava can affect ICV filter placement

• Venous abnormalities – Vena cava or vein constriction could also be a challenge for the surgical team in their quest for the successful placement of the filter

• Thrombus or stricture may account for this kind of narrowing

• Extrinsic compression

• Damaged blood vessels

• ICV thrombosis

• Occurrence of infection or bleeding at the catheter insertion site

• An allergic reaction occasioned by the use of contrast material or injection

• Wrongful dislodging of IVC filter

• Breaking up of the IVC filter – When this happens, the IVC filter piece might travel to the lung or heart, leading to injury or death

• Scarred retrievable filters that are hard to remove

• Pulmonary embolism

• Kidney failure

Retrievable filters are characterized by a higher rate of complications in comparison with non-retrievable filters.

Recovering after an IVC filter implantation 

Most people get back to work after 24 hours following an IVC filter procedure. This is true for patients in whom the IVC filer gets inserted via a jugular vein.

In case of a groin vein insertion, one should desist from driving within 24 hours of the surgery. 

You must also not climb stairs or lift heavy objects for the duration of 48 hours. 

Your surgeon will organize a follow-up appointment 4 to 6 weeks following surgery to check and establish that all is well. 

Cost of an IVC Filter Implantation in India

• The cost of the IVC filter procedure in India varies based on several factors

• Type of hospital: Private hospitals charge more for IVC surgery compared to public hospitals

• Type of filter: Permanent filters are typically more experienced than temporary filters

• The complexity of the procedure – If the patient has had other IVF filter procedures or has a preexisting health condition such as diabetes or kidney failure the cost of an IVC filter could be more due to the complexity involved

Below is a list of the average cost of IVC filter implantation in selected cities across India:

In choosing a healthcare facility in India where to have an IVC filter as a foreigner, make sure to also factor in the daily commute cost to and from the hospital, food, accommodation, and travel expenses.

Some healthcare facilities offer subsidized packages for their international clients that also include Visa processing and hotel booking.

Make sure to shop around for the most cost-effective package.

Other considerations for an IVC Filter placement surgery in India are:

• The years of experience by your surgeon – More experienced surgeons are likely to charge a premium price for their services

• The kind of tests ordered by your surgeon will increase the overall cost of surgery

It is important to consider choosing healthcare facilities that have received the necessary accreditations and certifications from pertinent healthcare authorities in India to administer IVC filter placement surgery.

Look for patient testimonials for IVC filter placement surgeries on the websites of healthcare facilities you may be interested in.

Check the hospital infrastructure and facilities available at the healthcare facility you may be interested in.

References

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