A team approach to IVC filter care
The Nebraska Medicine Interventional Radiology (IR) department provides comprehensive care for patients who need inferior vena cava (IVC) filters, from initial placement through eventual removal. Our team partners with referring providers to ensure optimal outcomes at every stage of treatment.
When to consider IVC filter placement
The decision to place an IVC filter arises in specific clinical scenarios. "We are typically consulted for a patient who has developed a deep vein thrombosis, and they may also have a blood clot that has traveled upward to their lungs," explains interventional and diagnostic radiologist Maria O'Malley, MD. "And for whatever reason – maybe the patient has GI bleeding, very low platelets, or recent surgery – the patient is not able to take anticoagulants."
Filter placement may also be appropriate in certain planned scenarios. As Dr. O'Malley notes, "We are occasionally asked to place a filter if a patient has a planned surgery. For example, if a patient has knee surgery coming up and they are on blood thinners chronically, we can place the filter so the patient can be taken off of the blood thinners in the peri-operative period."
Not all blood clots require filter placement. Dr. O'Malley emphasizes important distinctions, "Not every vein in the leg is considered a deep vein. There are some that are considered superficial and those are not at high risk of having that blood clot travel to the lungs." Additionally, chronic deep vein thromboses are not an indication for filter placement.
The removal decision
While filters provide important protection during high-risk periods, they're designed to be temporary. "Generally, we say that the filter should be removed by 90 days to avoid complications," Dr. O'Malley says. "If you have a generally healthy person who is now able to tolerate anticoagulation, you can very easily determine that the filter should come out.'"
However, timing of removal varies based on individual circumstances. "Unfortunately, a lot of our patients are very sick, and they may have ongoing complexities that make them unable to tolerate anticoagulation," says Dr. O'Malley. "While best-case scenario is that a patient can start anti-coagulation soon after filter placement, it's often more complicated."
The IR team maintains oversight of all IVC filters placed at Nebraska Medical Center through a systematic tracking process. “At the end of 30 days, we begin reviewing patient charts to determine whether they may be medically appropriate for removal,” Dr. O’Malley says. “We then reach out to the referring provider or primary care physician – if the contact information is available – to coordinate the best approach for future removal, keeping in mind our general goal of removal by three months.
Advanced retrieval options
Both placement and removal procedures are typically straightforward. "For most filters that haven't been in for many years, it's a very simple procedure," Dr. O'Malley explains. "It's done on an outpatient basis under moderate sedation and requires only a tiny puncture in the neck or in the groin. Patients typically stay in recovery for one hour after procedure, and then may discharge home if there are no issues. “
In cases when filters have been in place for many years, the procedure may require general anesthesia and overnight observation. “Thankfully, these more complex cases are uncommon,” Dr. O’Malley says. “About 90% of the time, patients spend a couple hours at the hospital and go home the same day.”
Importantly, even long-standing filters may be candidates for removal. "Having had it in for many years does not mean it cannot be removed if it is in the patient’s best interest," Dr. O'Malley says. "We have many advanced techniques we can employ if the patient has symptoms related to the filter and is able to tolerate the removal, typically under general anesthesia."
When to refer your patients
Consider IVC filter evaluation for patients who:
- Have acute DVT or PE and cannot tolerate anticoagulation.
- Need to temporarily discontinue anticoagulation for surgery.
- Have clotting disorders and have failed anticoagulation therapy.
- Have existing filters that should be evaluated for removal.
Partner with our team
Whether your patient needs filter placement or removal evaluation, our team will work closely with you to ensure appropriate timing and comprehensive care throughout the treatment process.
To inquire about the IVC filter program or refer to Interventional Radiology, contact:
Nebraska Medical Center
Phone: 402.559.8574
Fax: 402.559.3050
Bellevue Medical Center
Phone: 402.763.3239
Fax: 402.763.3198