Indications

• Contraindication to or complication of anticoagulation

• Failure of anticoagulation

• Significant cardiopulmonary disease with low reserve for additional PE

• Perioperative pts with recent hx of venous thromboembolism (VTE) who must come off anticoagulation

• Several others that are more controversial:

  • • Mobile iliocaval thrombus

    • Massive PE treated with thrombolysis or thrombectomy

    • As ppx for pts with NO VTE but who are at high risk and can’t be anticoagulated (severe trauma, ICH, high-risk surgery)

Contraindications

• Complete occlusion or absence of IVC

• Absence of adequate access site (can be done IJ or femoral approach)

• Severe uncorrectable coagulopathy or systemic infection (not common)

• Contrast allergy (CO2 can be used if necessary)

Imaging Review

• If available, review CT and Doppler imaging for:

  • • Variant venous anatomy (IVC atresia or duplication, megacava 28mm)

    • IVC and access site patency (infrarenal placement is ideal)

    • Extent of DVT

Tips for Workup

• Consent:

  • • Today’s filters (Bard Denali, our brand here) are meant to be retrievable. Make sure pt is aware of this and the risks of leaving it in place too long.

    • Filter migration (1-3%), filter fracture/penetration, arrhythmia, air embolism, access site thrombosis/hemorrhage/infection, increased risk of subsequent DVT or caval thrombosis.