What Filter Look Like For Blood Clot In Lung

Inferior vena cava filters are a class of preventative treatment for pulmonary embolism (PE). While they are an important tool in the earth of thrombosis, there is a lot of confusion about what these filters exercise and who they should be used for. Dr. Piotr Sobieszczyk, a member of the interventional cardiology team at Brigham and Women'south Hospital, was kind plenty to speak with NATF and to shed some light on this frequently misunderstood preventative treatment.

IVC filter with quarter for size comparison

What is an IVC filter?

"An IVC filter is a metallic umbrella or metal scaffolding, which is placed in the inferior vena cava to filter the blood flowing from the legs to the veins," explained Dr. Sobieszczyk. "It is designed to capture claret clots that may develop in the legs and dislodge, keeping them from migrating and going to the pulmonary artery."

The inferior vena cava (IVC) is the largest vein in the trunk and is responsible for bringing blood from the legs to the heart and lungs. In patients with deep vein thrombosis (DVT), blood clots can intermission off and travel to the lungs through this vein, causing pulmonary embolism (PE). IVC filters deed as a internet, allowing blood to flow through them but catching the claret clots before they achieve the lungs.

IVC filters are not the best treatment for everyone. They are for patients with existing DVT, who cannot safely be on anticoagulation therapy. This may be because their bodies don't react well to anticoagulation medications or they tin't be on the medication for a procedural reason. For case, filters may be used in patients who need their anticoagulation treatment interrupted for surgical reasons.

Permanent vs. Retrievable

There are two types of filters that doctors utilise, permanent filters and retrievable filters. The different uses of both accept evolved profoundly over time.

"[The permanent filter] has been around for several decades and initially information technology was a rather bulky device," explained Dr. Sobieszczyk. "It was a surgical process that required an incision in the vein and the leg and positioning through a very large port catheter."

Today, IVC filters are implanted through an IV or catheter that is placed in the common femoral vein, which can be found on top of the leg and hip joint, or in the jugular vein. Physicians tin implant them through other veins, but the jugular vein and mutual femoral vein are the most mutual. It is considered a minimally invasive surgery, involving only local anesthesia.

Permanent filters are currently used if the hazard of a recurrent blood clot is high and anticoagulation therapy is not an option. This could exist patients whose bodies' react negatively to blood thinners or patients who experience recurrent PE, despite being on anticoagulation therapy. Greenfield filters and Trapeze filters are an example of permanent filters.

Retrievable filters were developed after permanent filters, when doctors realized their patients would do good from something more than temporary.

"With the technological advances and the recognition that many patients would do good from temporary protection and temporary filter placement, there was involvement in developing a filter that could be put in for an unspecified period of fourth dimension during which the patients were vulnerable and could not be anticoagulated and needed some protection from a PE," explained Dr. Sobieszczyk. "But [the filter] could then, with render of health or anticoagulation… exist retrieved and not in place forever. That led to the advent of retrievable filters."

Retrievable filters are at present the near commonly used. Their blueprint is similar to that of permanent filters, simply they are built to be retrieved after several months, one time the danger of a PE has gone downwardly.

What are the risks of an IVC filter?

As with all medications and medical procedures, the IVC filter comes with its own set of risks and complications.

"The risks associated with IVC filter placement are related to it being a foreign body, which in itself has a small gamble of triggering thrombus formation in the IVC filter," noted Dr. Sobieszczyk. "We know that over time, IVC filters are associated with increasing the risk of DVT."

In some cases, metal fragments from the filter tin break off and flow to the middle and lungs. However, Dr. Sobieszczyk noted that this is very rare in more modernistic devices. Filters tin can also move from where they were originally placed or can penetrate the walls of the IVC.

In club to avoid these risks, it's important that patients receive follow-up care after they've had a filter put information technology. This is especially of import for retrievable filters, which should be removed every bit soon as they aren't needed.

"The need for the filter should be reassessed on a regular basis and retrieved as soon as possible," explained Dr. Sobieszczyk. "With a retrievable filter, a bones main is that you need to reassess and reevaluate the patient on a regular basis. How oft depends on what the indication for the IVC filter was."

Retrievable filters should ideally be removed within six months, yet a disconnect in patient care can cause a breakup in this process. Dr. Sobieszczyk has seen patients with these filters nonetheless in two years after their placement.

"The longer you wait, the harder information technology becomes to retrieve the filter," remarked Dr. Sobieszczyk.

He stressed the importance of self-advancement in patients. They need to serve every bit their own advocates and ask their md about filter removal. Awareness around the differences between permanent and retrievable filters can be lacking among some physicians, which can atomic number 82 to filters beingness in place for too long.

What lies in store for the future of filters?

According to Dr. Sobieszczyk, fewer and fewer filters are being implanted. Doctors are more selective of which patients demand them. They take also become better at following upwardly with patients for filter retrieval. There is an increasing focus on rubber, both in how patients are cared for and in the design of the filters themselves.

"There's a constant bulldoze to make these filters safer and less likely to cause whatsoever mechanical problems," Dr. Sobieszczyk explained. "In that location'due south abiding development of easier to recollect filters"

As filters get safer, their importance in the boxing against thrombosis grows. They are an important preventative tool for the patients who rely on them. Increased patient and provider sensation is central to ensuring patients using them receive the best intendance possible.