Endovenous Placement of Inferior Vena Caval Filters

The superior design of the Greenfield filter (Boston Scientific, Natick, MA), with its low rate of caval thrombosis, allowed it to rapidly supplant prior filter designs. Although anticoagulation is the mainstay of therapy in patients with acute deep venous thrombosis (DVT) or pulmonary embolism, it may be contraindicated in patients with active or increased risk of internal bleeding. The routine use of IVC filters in patients with PE who are receiving concurrent anticoagulation is not indicated for most patients. IVC venography should be performed during insertion of a filter for several reasons: (1) the location of the renal veins may be determined, (2) the presence of anomalies of the IVC may be detected, (3) the diameter of the IVC may be measured, and (4) the presence of thrombus in the IVC may be visualized. Complications include pneumothorax, access site thrombosis, filter fracture and migration, filter perforation, vena caval thrombosis, and, rarely, infection or trauma to surrounding structures. Indications for placement of retrievable filters and several techniques for their removal are briefly discussed.