Venous Disease
Inferior Vena Cava (IVC) Filter Placement
Sometimes a clot can form in the big veins of the legs. This is known as a deep venous thrombus (DVT). This condition is usually treated by placing the patient on blood thinners and possibly removing or dissolving the clot directly. In some cases, this may not be possible or successful. In those cases, the clot may break apart and flow from the legs through the big the big vein in the abdomen - the inferior vena cava (IVC) – and travel through the heart to the lungs. When this happens, it is known as a pulmonary embolism (PE), and it can be life threatening. In order to prevent this, the Interventional Radiologists at HRA can place a little metal filter in that big vein, known as an IVC filter.
Using real time ultrasound and x-ray guidance, a small hollow tube is placed into the vein of the neck or leg. This tube is advanced to the IVC and contrast is injected to evaluate the clot and anatomy. After confirming that it is safe, a filter is advanced through the hollow tube into the vein, where it is released.
The procedure has a low risk of bleeding, infection, and damage to nearby organs. Additionally, the filter may not stay where it is placed, penetrate through the vein into nearby structures, or – over time – break. Patients should refrain from eating and drinking for at least 6 hours prior to the procedure so that we may give them medications to help them relax (moderate sedation). We can perform for the procedure for both inpatients and outpatients, who usually return to their room or home after an hour.
Inferior Vena Cava (IVC) Filter Retrieval
As described above, an IVC filter is a little metal cage like device that sits in the big vein that drains the legs to the heart/lungs. It is placed to prevent clots in the legs from moving to the lungs (known as a pulmonary embolism – PE), which can be life-threatening. Typically, they are placed when a patient cannot receive blood thinners to treat known clots or when a patient is at a very high risk of forming a clot. These underlying conditions often resolve with time. When the risk factors for PE have resolved, a patient may no longer need their IVC filter. In those cases, we usually recommend retrieving the filter to prevent the filter from causing problems over time.
Using real time ultrasound and x-ray guidance, a small hollow tube is placed into the vein of the neck or leg. This tube is advanced to the IVC and contrast is injected to evaluate the clot and anatomy. After confirming that it is safe, a filter is advanced through the hollow tube into the vein, where it is released.
The procedure has a low risk of bleeding, infection, and damage to nearby organs. Additionally, the filter may break or move while trying to remove it. Patients should refrain from eating and drinking for at least 6 hours prior to the procedure so that we may give them medications to help them relax (moderate sedation). We can perform for the procedure for both inpatients and outpatients, who usually return to their room or home after an hour.
Venous Malformation Management
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Venography/Venoplasty/Stent Placement
Veins can become narrowed for a wide variety of reasons, such as compression from other structures or damage from other procedures/dialysis. If a vein draining an organ/limb gets too narrow, the organ may dysfunction and limb may swell.
Patients with significant symptoms can be evaluated with latest non-invasive imaging techniques including contrast enhanced CT venography or MR venography. In some cases, it may be necessary to perform an invasive, digital subtraction venogram. Using real time ultrasound and x-ray guidance, a small hollow tube is placed into the vein of the neck, arm, or leg. This tube is advanced to the area of interest and contrast is injected to evaluate the veins.
If a narrowing is identified, it can be treated with a balloon and/or stent.
The procedure has a low risk of bleeding, infection, and damage to nearby organs. Additionally, the filter may break or move while trying to remove it. Patients should refrain from eating and drinking for at least 6 hours prior to the procedure so that we may give them medications to help them relax (moderate sedation). We can perform for the procedure for both inpatients and outpatients, who usually return to their room or home after an hour.
