Slide 1: Sharkawy M.I
Professor of Vascular Surgery
Faculty of medicine
EGYPT I.V.C FILTER : I.V.C FILTER THE MOST RECENT WAY TO FILTER THE BLOOD PASSING THROUGH IVC
TO GUARD AGAINEST PULMONARY EMBOLI History : History John Hunter Ligated femoral vein 1784 .
Bottini IVC ligation 1893.
IVC suture , Stappling were developed 1930 .
Mobin-Uddin umbrella was developed 1951 . Absolute Indications : Absolute Indications DVT, PE in a patient with contraindication to anticoagulation .
DVT + PE despite adequate anticoagulation.
Complication of anticoagulation .
After pulmonary embolectomy .
During local thrombolytic therapy in a major vein DVT (Iliofemoral ). Slide 9: Lt. CIV compression syndrome Relative Indication : Relative Indication A large free floating ilio-femoral thrombus +
→Propagation of ilio-femoral DVT despite adequate anticoagulation .
Chronic PE in patient with core pulmonale or pulmonary hypertension .
More than 50 % occlusion of pulmonary vascular bed .
Recurrent septic embolism.
During surgical thrombectomy. Pulmonary Embolism : Pulmonary Embolism Is a common dissease .
Is a lethal dissease .
Is a preventable dissease . Slide 17: Prevent fatal pulmonary emboli not all PE THE AIM IS
TO IVC Filter Shapes : IVC Filter Shapes Cone shaped
With or without hooks VenaTech LGM - Permanent VCF : VenaTech LGM - Permanent VCF Cone The one piece and proven conical shape effectively traps clots while maintaining caval patency Hooks The hooks ensure precise filter placement and prevent filter movement Stabilizers The stabilizing legs center the filter on deployment and prevent tilting. The long legs minimizes vessel trauma and incidence of caval perforation. Crampons The crampons maintain the stability of the filter and promote rapid endothelial growth Slide 22: CENTRAL caudal extension for EASY Snaring and Removal BARBS for OPTIMAL resistance to migration Technical Considerations : Technical Considerations Venous access under local anesthesia .
Passing a guide wire and venography to IVC (less than 30mm , patent )
The right way (femoral – Jugular )
Filter deployment .
Check venography . Access : Access Femoral
Cephalic Durability : Durability Permanent Filter
Short Term Temporary Filter
Long Term Temporary Filter
Filter retrieval System Slide 30: “Short term” Temporary filters
Indicated to provide protection during thrombolysis.
Catheter left in and out the body Up to 10 days Slide 32: Benefits
Allows the insertion of a 3 French catheter for directed thrombolysis
MRI compatible Slide 33: “Long Term” Temporary filters
when temporary filter is needed for a long time (ex. surgery, pregnancy)
Fully implanted (patient can stay outside the hospital) Up to 6 weeks Problems : Problems Mal-alignment .
Filter Migration .
Filter occlusion .
Filter perforation .
Incomplete opening .
IVC Thrombosis MESSAGE : MESSAGE Adhere to strict indications only
Proper anticoagulation means
●The international incidence of IVC filter implantation rate is:
0.2% in all diagnosed infra-inguinal DVT
1-2% of Ilio-femoral DVT.
2-5% of post-pelvic surgery DVT Slide 38: Thank You