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Semin intervent Radiol 2021; 38(02): 243-250
DOI: 10.1055/s-0041-1727102
How I Do It

Over-the-Wire Inferior Vena Cava Filter Placement: How We Do It

Xin Li
1   Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Jennifer Montgomery
2   Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, Ohio
,
Levester Kirksey
3   Department of Vascular Surgery, Cleveland Clinic Main Campus, Cleveland, Ohio
,
Sameer Gadani
2   Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, Ohio
,
Giuseppe D'Amico
4   Department of Transplant Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
,
Sasan Partovi
2   Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, Ohio
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Inferior vena cava (IVC) filter placement is routinely performed in selected clinical settings to protect patients from thromboembolism to the lungs. The absolute indications for IVC filter placement include patients who have failed or have absolute contraindications to anticoagulation in the setting of acute venous thromboembolic disease (VTE), such as pulmonary embolism (PE) and deep vein thrombosis (DVT). The relative indications are variable based on society guidelines and include patients who are candidates for anticoagulation but have large free-floating proximal DVT or poor cardiopulmonary reserve. Along with the expansion of relative indications, the advent of retrievable IVC filter has also led to a significant growth in the number of filter placements in previous years. Overall from 1993 to 2010, the number of annual filter placement increased from 28,000 to 130,000, representing a 358% increase.[1] In the subsequent years, the filter utilization has decreased due to a combination of Food and Drug Administration (FDA) advisory and legal effort, although the number of IVC filter placements remains high.[1] Along with the high filter placement, there has been a growing number of filter complications, including filter fracture, migration, tilting, and long-term complications such as postthrombotic syndrome.[2] [3] Among those, filter tilt often occurs during the immediate periprocedure timeframe and is associated with a decrease in filtering efficiency and an increase in retrieval difficulties. Many methods have been utilized to minimize filter tilt and one possible option is the use of the over-the-wire (OTW) technique, during which the OptionElite filter (Argon Medical Devices, Plano, TX) is deployed over a 0.035-inch guidewire. Similar to an OTW stent placement, the guidewire facilitates centering the filter within the IVC, thereby preventing filter tilt. Based on our experience, placing IVC filter in OTW fashion has certain unique benefits over the standard technique, specifically in cases of a tortuous IVC course. In this article, the technique of OTW IVC filter placement is described and depicted in detail along with a review of the technique in the context of the literature.



Publication History

Article published online:
03 June 2021

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