IVC Filters: A Closer Look

Inferior vena cava (IVC) filters are a preventative treatment for pulmonary embolism (PE). While these devices play a crucial role in thrombosis management, many patients and healthcare providers still have questions about their use, effectiveness, and risks.

Dr. Piotr Sobieszczyk, an interventional cardiologist at Brigham and Women’s Hospital, shared insights with VLN to help clarify who benefits from IVC filters and how they should be managed.

What Is an IVC Filter?

An IVC filter is a small, metal device placed in the inferior vena cava (IVC)—the body's largest vein—to capture blood clots before they reach the lungs.

“An IVC filter is a metal umbrella or scaffolding placed in the IVC to filter blood flowing from the legs to the veins,” explained Dr. Sobieszczyk. “It is designed to catch blood clots that develop in the legs and prevent them from migrating to the pulmonary artery.”

Who Needs an IVC Filter?

IVC filters are not for everyone. They are primarily used for patients with deep vein thrombosis (DVT) who cannot safely take anticoagulants due to:

• Adverse reactions to blood thinners

• Surgical procedures requiring temporary interruption of anticoagulation

• High risk of recurrent PE despite anticoagulation therapy

Permanent vs. Retrievable IVC Filters

There are two types of IVC filters: permanent and retrievable.

Permanent IVC Filters

Used for:

• Patients at high risk of recurrent PE

• Those who cannot tolerate blood thinners

“Permanent filters have been around for decades,” said Dr. Sobieszczyk. “They were initially inserted surgically, but today, they are placed through a minimally invasive procedure using a catheter.”

Retrievable IVC Filters

Used for:

• Patients needing temporary PE protection

• Those expected to resume anticoagulation therapy

Retrievable filters have become the most commonly used type. These filters function like permanent ones but are designed to be removed once the risk of PE decreases.

“The goal is to protect patients during a vulnerable period, then retrieve the filter when anticoagulation can be restarted,” Dr. Sobieszczyk explained.

Risks of IVC Filters

Like any medical procedure, IVC filters carry risks, including:

• Increased risk of DVT due to filter placement

• Migration or displacement of the filter

• Breakage of metal fragments, though rare in newer models

• Perforation of the IVC wall

One major concern with retrievable filters is failure to remove them when no longer needed.

“The longer you wait, the harder it becomes to retrieve the filter,” said Dr. Sobieszczyk. “Patients should be proactive in asking their doctors about filter removal.”

Retrievable filters should ideally be removed within six months unless there is a continued need for protection.

The Future of IVC Filters

Advancements in filter design and patient management have led to:

• More selective use of filters to ensure they are placed only when truly necessary

• Improved follow-up for timely retrieval of temporary filters

• Safer, more effective filters that reduce risks of migration and clot formation
  
  

“There is a constant drive to make these filters safer and less likely to cause complications,” said Dr. Sobieszczyk. “The goal is to refine retrieval techniques and ensure patients receive optimal care.”

Final Thoughts

IVC filters remain a valuable tool in preventing life-threatening PE, but they should be used only when necessary. Patients and providers must work together to:

• Determine if a filter is the right choice

• Monitor filter placement and function

• Remove retrievable filters as soon as possible

If you or a loved one has an IVC filter, talk to your doctor about whether it should be removed or monitored. Proper patient education and follow-up care are essential for the best outcomes.

Image Credit: https://www.saintlukeskc.org/health-library/understanding-inferior-vena-cava-ivc-filter-placement