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When a patient is diagnosed with deep vein thrombosis (DVT) or pulmonary embolism (PE) the treatment of choice is anticoagulation therapy. Patients who are unable to receive anticoagulants, have complications while taking these medications, or need to have these medications held for surgery or other procedures should receive an IVC filter. The IVC Filter Clinic staff and the department of Interventional Radiology can provide consultation on these patients, place retrievable or permanent IVC filters, assist in scheduling, provide patient and staff education, and will follow up on all retrievable filters placed. The indications for permanent verses retrievable IVC filter placement should be evaluated for each individual patient.

Our clinic is also happy to assist in the retrieval of IVC filters placed at outside hospitals or filters that were not able to be removed in the past or were determined to be high risk or challenging filter removals.  We have had great success in using advanced techniques to remove these filters which include an Excimer Laser Sheath or Endobronchial forceps.  Please see the advanced removal techniques tab to learn more about the use of the laser sheath.

Consults can be arranged by contacting our IVC Filter Clinic Coordinator
Physician consultations
Robert Lewandowski, MD
Kush Desai, MD
To refer a patient
Please contact the IVC Filter Clinic Coordinator for any questions or scheduling needs:

Jennifer Karp RN, BSN, CRN
676 N. St. Clair Street, Suite 1400
Chicago, IL 60611
Phone: 312.926.5289
Fax: 312.695.0654
E-mail: [email protected]

Requirements for IVC Filter Placement and Retrieval:

Order for procedure, PT/INR, PLT, Creatinine/GFR within one month of requested procedure

Permanent IVC Filter Indications
  1. Permanent contraindication to anticoagulation.
  2. Complication or inability to achieve therapeutic dose of anticoagulants.
  3. Elderly patients- This should be evaluated on a case by case basis.
  4. Poor Prognosis- Survival < 6 months.

Retrievable IVC Filter Indications
  1. Risk of VTE is temporary.
  2. Contraindication to anticoagulation is temporary.
  3. Free-floating or proximal DVT/iliocaval DVT
  4. Massive PE treated with Thrombolysis/thrombectomy
  5. VTE with limited cardiopulmonary reserve Prophylactic indications in patients without VTE
                        a. Trauma patients at high risk for 
                             VTE (polytrauma/spinal injuries) 
                        b. Surgical procedures with high risk of VTE 
                            (bariatric, pelvic, orthopedic)
                        c. Medical conditions with high risk of VTE 
                            (thrombophilia)

Potential Complications Associated with Filter Use
  1. Tilting, migration, or fracture of the filter in the IVC.    
  2. Permanent Filters and Retrievable Filters left in place indefinitely.

Both permanent and retrievable filters left in place indefinitely carry the same risks which include:
  1. IVC occlusion with resultant chronic leg edema, hyperpigmentation, and ulceration
  2. Venacaval Syndrome
  3. Increased risk of subsequent DVT

Retrieval of a Filter
The IVC Filter Clinic coordinator and an Interventional Radiologist will follow each patient that receives a retrievable filter in the department of Interventional Radiology and will work with you to assess each patient for safe retrieval. One of our staff members will contact the patient’s primary or managing physician within 2-4 weeks after placement in regards to removal of the filter.
Patients that are eligible for filter retrieval will be scheduled for a CT of the abdomen and pelvis if indicated to assess for clots within the filter. Some indications for ordering a CT before filter removal are:
  1. Increased swelling or pain in the patients legs
  2. Pain in the patients back or abdomen
  3. A high risk for clots to be trapped in the filter
  4. Clots were seen in the IVC during filter placement
  5. An anticipated difficult retrieval procedure

The patient may then be seen in the IVC Filter Clinic if they were not seen as an inpatient or outpatient before the filter was placed. Finally, the filter clinic coordinator will schedule the patient for filter removal in the department of Interventional Radiology.

Retrievable filters can be left in place permanently if indicated or removed and replaced again as the patients’ condition changes.

We also can assist in the retrieval of filters placed at outside hospitals.

Indications for Retrieval
  • Patient is currently at low risk for PE

With Venous Thromboembolism (VTE)
  • Patient has tolerated and reached a therapeutic dose of anticoagulation (usually for at least 2-3 weeks)
  • There is no clinical evidence of VTE recurrence

Without VTE
  • Prophylactic anticoagulation therapy has been started
  • Risk factors for VTE have been resolved
  • Normal bilateral lower extremity venous duplex ultrasound
 
  • Patient is compliant with anticoagulation medications and follow up care.
  • Life expectancy >6 months.
  • Patient has an unlikely chance of returning to high VTE risk.

Occasionally, new thrombus is found trapped in the filter during the pre-removal CT or during the removal procedure on venogram. In this case it is likely the filter will not be removed at this time and the patient should be treated with anticoagulation. The IVC Filter Clinic staff will continue to follow these patients until it is determined to remove the filter at a later time or leave the filter in place indefinitely.
IVC Filter Clinic | Northwestern Medicine