Vena cava filter

Appointments – Freeman Hospital: (0191) 223 1012 RVI: (0191) 282 5627

What is a vena cava filter?

A vena cava filter is a small, metal device about an inch long, shaped rather like the spokes of an umbrella. The filter is placed in the vena cava, which is the large vein in the abdomen that brings blood back from the legs and pelvis, towards the heart. If there are blood clots in the veins in the legs or pelvis, these could pass up the vena cava and into the lungs and cause severe illness or even death. The filter will trap these blood clots and prevent them entering the lungs and causing problems.

Why do I need a vena cava filter?

Usually you will be taking blood-thinning drugs, “anticoagulants”, which either have caused problems with bleeding or need to be stopped because of a planned operation. Sometimes blood thinning alone has not been enough and a filter is needed as well.

Who has made the decision that I should have a vena cava filter?

The consultant in charge of your case and the interventional radiologist who will be putting the vena cava filter in will have discussed the situation and feel that this is the best treatment option. However, you will also have the opportunity for your opinion to be taken into account and if, after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

Who puts the vena cava filter in?

The examination will be performed by a doctor called an interventional radiologist who has expertise in using x-ray equipment to guide treatments.

Where will the treatment take place?

This generally takes place in the Interventional Radiology Department in an “angiography” room which contains specialised medical and imaging equipment.

How do I prepare for a vena cava filter?

You need to be an in-patient in the hospital. We will ask you to put on a hospital gown. 

Please contact the hospital that you are attending below and we will advise you what to do:

If I am diabetic, does this change anything?

Yes.  If you are diabetic and take insulin, you may need a drip to keep your blood sugars controlled.  We will talk about this with you on the ward before the procedure (see next question also).

I take metformin (Glucophage, Avandamet) tablets. Does this change anything?

Yes – Metformin (Glucophage, Avandamet) is most commonly taken by diabetic patients to control blood sugar, but occasionally is taken for other conditions.  If you are taking Metformin, your preparation for the procedure may change.  Please ring our helpline telephone number at the hospital you are attending (shown below) and speak to a member of staff who will be able to advise you:

What does the examination involve?

You will lie on the x-ray table, generally flat on your back. You may also have a monitoring device attached to your chest and finger.

The interventional radiologist will keep everything as sterile as possible and will wear a theatre gown and operating gloves. They will use antiseptic to clean the skin near the point of insertion, probably the neck or possibly the groin.  Most of the rest of your body will be covered with a theatre towel.

We will numb the skin and deeper tissues over the vein with local anaesthetic (see below).  Your procedure will only go ahead when you and your radiologist are sure that the area is numb.  Then a needle will be inserted into the vein. Once the interventional radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle and into the vein. Then the needle is withdrawn and a fine plastic tube, called a catheter, is placed over the wire and into the vein. This catheter has the filter attached to it.

Image guided insertion:

The interventional radiologist uses the x-ray equipment to make sure that the catheter and the wire are moved into the right position.  They will then take the wire out and the filter can be released from the catheter and left in place in the Vena Cava.

We will then take out the catheter.  The interventional radiologist will press firmly on the skin entry point for several minutes to prevent any bleeding.

Your radiologist is always near to you and you can speak to them whenever you want to.

 During the injection of local anaesthetic:

Your radiologist will ask you to keep quite still while the injections are given.

 You need to complete a consent form for this procedure:

Some of your questions should have been answered above, but this is only a starting point for discussion about your treatment with the doctors looking after you. Your radiologist will discuss this examination with you and be able to help with any questions or concerns you may have.

Please make sure that you are satisfied that you have received enough information about the procedure, before you sign the consent form.

Insertion of a vena cava filter is considered a very safe procedure, designed to prevent the serious complications that can develop from blood clots. There are some slight risks involved and although it is difficult to say exactly how often these occur, they are generally minor and do not happen very often.

What happens afterwards?

You will be taken back to your ward on a trolley. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. They will also look at the skin entry point to make sure there is no bleeding from it. You will generally stay in bed for a few hours, until you have recovered. You may be allowed home on the same day or kept in hospital overnight.

How long will it take?

Every patient’s situation is different and it is not always easy to predict how complex or how straightforward the procedure will be. Generally, the procedure will be over in about half an hour, but you may be in the x-ray department for about an hour altogether.

How does it feel?

Some discomfort may be felt in the skin and deeper tissues during injection of the local anaesthetic. After this, the procedure should not be painful.  You will be awake during the procedure and able to tell the radiologist if you feel any pain, or become uncomfortable in any other way.

What are the benefits of having a vena cava filter?

As discussed above, vena cava filters can be used instead of blood thinning medications and are designed to prevent the serious complications that can develop from blood clots.

What are the risks of having a vena cava filter? Are there any side effects?

Vena cava filter insertion is a very safe procedure, but there are some risks and complications that can arise. There may occasionally be a small bruise, called a haematoma, around the site where we put the needle in and this is quite normal. If this becomes a large bruise, then there is the risk of it getting infected and you would then need treatment with antibiotics.

Very rarely, some damage can be caused to the vein by the catheter and this may need to be treated by surgery or another radiological procedure. There is a possibility that the filter will actually cause some blockage of the vena cava. This is the large vein that brings blood back from the legs to the heart and because of this there may be some swelling of the legs. As with any mechanical device, there is also the possibility that the filter will eventually fail to work properly. Despite these possible complications, the procedure is normally very safe and is carried out with no significant side effects at all.

When will I get the results? What follow up care should I expect?

A report will be sent to the consultant who asked for this test to be performed within one week. Your consultant will see you in clinic. Usually we will plan to remove the filter when it is no longer needed, ideally within 90 days. This is done in the same way as the filter is put in.

I need an ambulance/ transport. Do you arrange it?

No.  If you need an ambulance/ transport, you should ask your GP Surgery to arrange it. You will need to give them three working days’ notice.  Please note that hospital transport is provided on medical need only.

What if I cannot attend for my appointment?

If your appointment time is not convenient please contact the hospital department so that a more appropriate time can be arranged.  This will enable us to reallocate valuable scanning time to someone else.

Diagnostic Imaging Dataset

Information from your diagnostic test will contribute to the Diagnostic Imaging Dataset. 

The Diagnostic Imaging Dataset (DID) is a database that holds information on the imaging tests and scans carried out on NHS patients. This will allow the Health and Social Care Information Centre to see how different tests are used across the country.

Nothing will ever be reported that identifies you.  All information is stored securely. It is only made available to appropriate staff, and is kept strictly confidential. However, if you do not want your information to be stored in the DID, please tell the people who are treating you. They will make sure your information is not copied into the DID.

You may, at a later date, still decide to opt out.  Please contact the Health and Social Care Information Centre directly, their contact details are:

Telephone: 0845 300 6016 

Email: enquiries@ic.nhs.uk

Website: www.ic.nhs.uk 

What if I have any comments, suggestions or complaints?

Should you have any suggestions or concerns, please make these known to the person conducting your examination or by letter addressed to the hospital that you are attending your examination:

The Departmental Manager                      

X-ray Department Level 3, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP    

Telephone: (0191) 282 1099 

Or:

The Departmental Manager 

Main X-ray Department, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN 

Telephone: (0191) 282 1099

Monday to Friday 8.30am to 5.00pm

Switchboard: (0191) 233 6161 (24 hours)

The Patient Advice and Liaison Service (PALS) can offer on-the-spot advice and information about the NHS. You can contact them on freephone 0800 032 02 02 or email northoftynepals@nhct.nhs.uk

Information produced by: Dr Ralph Jackson, Clinical Directorate of Radiology