IVC Filter
Placement & Retrieval

Indications

• Absolute — PE or DVT + anticoagulation contraindication
• Absolute — recurrent PE despite therapeutic anticoagulation
• Relative — massive PE, compromised cardiopulmonary reserve
• Relative — free-floating iliofemoral thrombus
• Relative — high-risk surgery with PE or DVT history
• Relative — poor anticoagulation compliance or high fall risk
• Prophylactic — high-risk trauma, bariatric surgery (selective)
• NOT indicated — routine DVT without anticoagulation contraindication

Filter Types and Placement

• Retrievable filters — Celect, Günther Tulip, Option Elite
• Permanent filters — Greenfield, Bird's Nest (large IVC)
• Access — right IJ (preferred) or common femoral vein
• IVC venogram — measure diameter, identify renal veins
• IVC diameter limit — standard filter ≤28 mm; large-IVC filter ≤40 mm
• Infrarenal placement — below lowest renal vein
• Suprarenal placement — renal vein thrombus, pregnancy, prior filter
• CT or fluoroscopy confirmation — filter position and expansion

Retrieval and Complications

• Retrieval window — ideally within 29–54 days (FDA guidance)
• Retrieval access — right IJ, snare technique
• Tilted filter — advanced retrieval techniques (forceps, sheath)
• Embedded struts — >6 months dwell, may require loop technique
• Filter thrombosis — CT diagnosis, anticoagulation
• IVC penetration — struts through IVC wall (common, often benign)
• Filter fracture — strut embolization to heart or PA
• Long-term IVC occlusion — bilateral leg swelling, chronic DVT

Related Procedures