The Dotter Interventional Institute at OHSU uses the most advanced, minimally invasive techniques for IVC filter placement and retrieval by our credentialed and board certified Interventional Radiology Team.
The goal of establishing a dedicated IVC filter clinic is to offer easy, convenient access to medical care to patients with or considering the placement and retrieval of an IVC filter. Our multidisciplinary collaborative team has decades of experience in each medical subspecialty, and our clinic is specially suited to provide an open and comprehensive referral center for patients and for providers requesting IVC filter placement, retrieval, or management.
Interventional Radiology is a unique and innovative branch of medicine with the Dotter Interventional Institute as one of the world leaders in technique, research, and design that continues to be at the forefront of continued improvement in IVC filters as well as advancements in insertion and retrieval methods.
Patient care is a priority. We provide the highest quality interventional treatment to patients in an environment that ensures safety, comfort, and well-being. We serve as a regional and national resource by advising other interventionalists and by accepting patient referrals in the management of difficult interventional cases, and at all times we consider patients and families as equal members of the treatment team.
What is an IVC filter?
The inferior vena cava (IVC) is the major blood vessel responsible for blood return from the legs and pelvis to the heart. An IVC filter is a small metal implant device positioned within the IVC that is designed to capture or to disrupt blood clots traveling from the legs to the lungs, heart, or brain.
Why was it placed?
An IVC filter is typically placed for a blood clot in the leg (deep vein thrombosis) or a blood clot in the lung (pulmonary embolism). Standard treatment is to start a blood thinning medication or anticoagulation therapy. Some patient cannot be anticoagulated because of bleeding, trauma, surgery, or medical instability and high risk. Some patients fail anticoagulation therapy - meaning that the blood clots progress or bleeding occurs related to the blood thinners. An IVC filter should be placed in those patients to protect against potential pulmonary embolism (PE).
There are many brands and makers of IVC filters. All are FDA approved for permanent use and placement. However, some are also approved for retrieval. Your specific medical condition may determine what type of filter you received, and which filter is right for you.
How are procedures performed?
Here at The Dotter Interventional Institute at OHSU, permanent and retrievable filters are placed using imaging guided, minimally invasive, sterile techniques, and are performed by specially trained interventional radiologists with moderate sedation in our dedicated interventional radiology suite.
Both permanent and retrievable IVC filters offer safe and effective prevention of pulmonary embolism (PE) with fewer complications than previously more invasive techniques.
During placement or retrieval of an IVC filter, there is a small risk for bleeding and infection, about 1/1000. Less likely, patient may develop a pneumothorax, separation of the lung from the chest wall. Filters may become severely tilted or penetrate the IVC limiting retrieval and causing injury to the vessel or nearby organs. Very rarely, some filters have been shown to fracture or significantly migrate over time resulting in bowel, heart, or lung injury and even less likely death. Commonly small insignificant clots become trapped or form within the filter. If a large clot develops behind the IVC filter, this can potentially cause obstruction of the IVC resulting in leg swelling, hyperpigmentation, or ulceration of the lower extremities. Long-term, IVC filters continue to protect against PE while in place, but have been associated with an increased risk of lower extremity deep vein thrombosis (DVT). There is a slight risk of allergic reaction or renal injury related to the contrast material used during the procedures.
Ask your doctor if you have more specific questions on the benefits and risks of IVC filter placement or retrieval.
Increased risk factors for deep vein thrombosis or pulmonary embolism
- Extended car or plane rides
- Hormone changes such as estrogen therapy, birth control pills, or pregnancy
- Cancer patients and cancer treatment
- Bedrest, immobility, hospitalized, in nursing homes, or in rehabilitation facilities
- Mobile patients undergoing minor surgery
- Patients having gynecologic, urologic, hip or knee, bariatric, orthopedic, neuro, or spinal surgery
- Major trauma or spinal cord injury
- Overweight and obesity
- Age over 50 are more likely to develop deep vein thrombosis
- Ethnicity: African Americans and Whites are more likely than other groups to develop deep vein thrombosis
DVT/PE symptoms, diagnosis, and prevention
Every year 350,000 – 600,000 Americans suffer from DVT/PE, and at least 100,000 deaths may be directly or indirectly related to VTE. Roughly one out of ten hospital deaths are related to PE.
DVT: swelling or edema, pain, and warmth to one leg.
PE: sudden cough, shortness of breath, chest pain, palpitations, and wheezing
Diagnosis of DVT/PE is based on individual patient risk factors, symptoms, labs, and imaging. Imaging can include ultrasound, CT scan, MR, and/or direct angiography.
- D-Dimer blood test- indication of blood clot
- Duplex Ultrasound- Ultrasound used to visually identify clots in the legs
- Venogram- gold standard for DVT diagnosis, contrast dye is injected in a vein and X-Ray pictures are taken to show clots inside the veins
- Chest X-Ray- rule out any other lung problems
- EKG- rule out any other heart problems
- Arterial Blood Gas (ABG)- blood test that measures the ventilation/perfusion mismatch and shows the amount of oxygen in the arteries
- CT Scan- Can confirm PE or other causes of symptoms
- Pulmonary Angiogram- Uses contrast dye and X-rays to views clots in the lungs
- Stay active- move around every few hours, take a short walk or move your feet up and down (like pressing on a gas pedal) while sitting, especially if you are on a long car or airplane ride
- Medications- Take anticoagulation medications exactly as directed by your doctorbr>
- Wear Compression stockings- helps blood to move from your lower legs back up to your heart
- Take anticoagulation medications exactly as directed by your doctor while in the hospital.
While in the hospital:
- Discuss with your doctor or nurse their plan to decrease your risk of developing DVT/PE while you are in the hospital. Northwestern Memorial hospital has patient education materials through NM Connect the hospital’s intranet that can be printed out and given to you by your nurse. (link NM connect to pt ed page if possible). These materials include information on IVC Filter placement and Retrieval, DVT, and anticoagulation medications such as Warafin Sodium, or Low Molecular Weight Heparins.
- Stay Active- Ask your doctor or nurse if it is OK to move your legs around while in bed, get up to a chair, or take a short walk.
- Wear Compression stockings or Compression devices while on bedrest- Your doctor may have compression devices placed around your legs to help blood move from your legs back up to your heart. These can be tight stockings or sleeves wrapped around your legs that inflate and deflate with air to help with circulation.
Complete and thorough planning for your procedure will be discussed at the time of your clinic appointment. Be prepared with a comprehensive list of your current medications and allergies. Routine blood draw may be required to evaluate kidney and clotting function. Occasionally, x-rays, ultrasounds, and other images may be necessary prior to filter removal. Women should always let their provider know if you are pregnant, trying to get pregnant, or if there is a possibility that you may be pregnant.
You should plan on eating a light dinner the night before the procedure with no meals or food after midnight. It is OK to drink clear fluids up to 2 hours prior to your arrival. Typically, we ask you to continue all medications as prescribed with an exception and modification to most diabetic medications and routines.We recommend you plan on the filter removal being an all day event. The procedure typically takes less than 1-2 hours; however, delays for emergencies are relatively common. Also, allergies and medications will be reviewed, an IV will be started for fluids and sedation, and recovery time is needed afterward. You should arrange for a friend or family member to drive you to and from the hospital.
OHSU Physician's Pavilion
2nd Floor, Room 220
Dotter Interventional Institute, IVC Filter Clinic
Oregon Health & Science University, L605
3181 S.W. Sam Jackson Park Road
Portland, OR 97239