From this article you will learn: what is a cava filter, what indications it is placed in the lower vena cava, how to prepare for the procedure of its implantation. The course of the installation and the course of the postoperative period.
Contents of the article:
- Types of cava filters
- Indications for implantation
- Contraindications
- Preparing for
- procedure Conducting implantation
- Postoperative period
- Possible complications
A cava filter( abbreviated CF) is a small medical metal device that is implanted in the lower vena cava to be trappedemboli( torn clots or blood clots) and prevent them from entering the pulmonary artery.
CF are one of the main and effective methods of preventing pulmonary embolism in deep vein thrombosis( abdominally DVT) of the legs and pelvis. This is a metal mesh that acts according to the principle of a sieve - it lets blood pass and detains blood clots. There are cava filters of various shapes, but most of them resemble an umbrella.
Click on photo to enlarge But not all patients with DVT need CF implantation in the lower vena cava. This minimally invasive procedure has its own indications and contraindications. It is also important to understand that the filter does not protect against deep vein thrombosis itself, it helps to prevent life-threatening thromboembolism of the pulmonary artery( PE).
Cava filter is usually installed by cardiac surgeons, interventional radiologists or vascular surgeons.
Types of cava filters
There are many types of CF that can be divided into two groups:
- Permanent - after implantation, the devices remain forever in the lumen of the inferior vena cava.
- Removable( temporary) - After a while after installation, these KF can be deleted.
Indications for implantation
The main indication for the installation of a cava filter is the prevention of PE in deep vein thrombosis. However, only a small proportion of patients with DVT need its implantation, most of them are receiving anticoagulant therapy( treatment aimed at reducing blood coagulability).
Absolute indications for CF in the presence of DVT or PE in combination with one of the following conditions:
- The presence of contraindications to anticoagulant therapy, which include hemorrhagic stroke, recent major surgery, severe or multiple trauma, active internal bleeding, hemophilia, pregnancy,a tumor of the brain.
- Recurrent thromboembolism despite anticoagulant therapy.
- Complications of anticoagulant therapy( bleeding).
Relative indications:
- The presence of a floating thrombus in the inferior vena cava or iliac-femoral segment( this pathology is associated with a 27-60% risk of thromboembolism).
- PE and breach of heart contractility.
- Prevention of thromboembolism in patients with severe trauma, spinal cord injury or paraplegia( paralysis of two legs).
- Prevention before surgical interventions in patients with DVT( especially before traumatologic operations on the legs, severe interventions on the abdominal organs and neurosurgical operations).
- Poor patient compliance with anticoagulant therapy guidelines.
- Protection during thrombolysis for the treatment of DVT.
The implantation of filters in the lower vena cava is used quite often, but it is surprising how little scientific research on their safety and effectiveness has been carried out. These studies showed a reduction in the incidence of pulmonary embolism, but also demonstrated an increased risk of deep vein thrombosis. Interestingly, the implantation of the cava filter did not improve the prognosis and did not lead to a reduction in mortality. Therefore, at present, their installation in most cases is carried out in the presence of contraindications to anticoagulant therapy or its inefficiency.
Contraindications
Absolute contraindication to CP implantation is the lack of access to the inferior vena cava.
Relative contraindications include the following conditions:
- Disrupted coagulation.
- Thrombosis of the inferior vena cava is higher than the place where the cavafilter should be installed.
- Bacteremia or sepsis( infection of the blood).
- The diameter of the inferior vena cava is less than 15 mm.
Some medical associations do not recommend implanting CF to patients who are receiving anticoagulant therapy or who have external drainage of the ventricles of the brain.
Preparing for
procedure Before the implantation of CF, the patient is subjected to a laboratory examination, which reveals abnormalities in the functioning of the kidneys and determines the coagulation of the blood.
Patient should tell doctors about all medications taken, as well as about the presence of any allergic reactions, especially local or general anesthetics, contrast agents containing iodine. The doctor can also before surgery cancel the use of aspirin, non-steroidal anti-inflammatory drugs or blood-thinning medications.
Women should always inform the medical staff if there is even the slightest possibility that they are pregnant. X-ray methods are not performed during pregnancy, so as not to expose the fetus to radiation. If, however, the use of X-rays is necessary, doctors take all possible precautions to minimize the impact of radiation on the baby.
After midnight before the procedure, you can not eat or drink anything. About what preparations in the morning on the day of implantation of CF can be taken, the doctor will tell.
Before the procedure, the patient needs to remove all jewelry, eyeglasses and other metal objects that can affect the radiographic examination.
Conducting implantation of
The procedure for the installation of CF is performed by vascular surgeons, cardiosurgeons or interventional radiologists in an X-ray operating room. Typical course of the operation:
- Before the procedure, an intravenous catheter is inserted into your arm, through which sedatives will be administered. These medicines will make you calm and sleepy.
- In the place of vascular access( groin or neck), the doctor treats the skin with an antiseptic, covers with sterile underwear and performs local anesthesia.
- A puncture of a large vein( femoral or internal jugular) is performed, through which a long and thin catheter is then inserted.
- Under the control of a continuous X-ray examination( fluoroscopy), the physician leads a catheter into the lower vena cava. To clarify its place of localization, contrast can be introduced.
- After confirming the location of the catheter in the right place, the doctor releases the cava filter from it. This device expands and is attached to the walls of the inferior vena cava.
- The catheter is removed, the vascular access site is pressed for a few minutes, after which a sterile bandage is applied to it.
Usually the duration of the whole procedure is less than 1 hour. After its termination the patient is transferred to the ward.
Click on photo to enlarge Postoperative period
After the procedure, the patient may be drowsy. At this time, carefully monitored his condition. If necessary, anesthetics are given. The patient may experience nausea or a headache that goes away on his own. A small hematoma may appear at the site of insertion of the catheter.
If CF was injected through the internal jugular vein around the neck, a person can restore normal activity level in a day. If the operation is carried out through the femoral artery, do not lift weights and walk the stairs for 48 hours.
All doctor's instructions should be carefully followed, which may include recommendations on the use of medicines, physical activity and wound care. Blood-thinning drugs can also be prescribed to help prevent blood clots.
Sometimes, patients need additional visualization tests to make sure that the filter is in the correct position. If the patient has a temporary CF, he may need a similar procedure in the future to remove it, which is carried out after reducing the risk of deep vein thrombosis.
The doctor should be contacted immediately if the following symptoms appear:
- Cold or numbness in one of the limbs.
- Bleeding at the site of vascular access, which does not stop at the pressure on this area.
- Edema, redness, fever and pain in the site of vascular access.
- Increased body temperature.
- Chest pain.
- Headache or nausea that does not go away.
Click on the picture to enlarge Possible complications of
Any, even the safest, medical procedure can have its risks. To complications of implantation of CF belong:
- Development of infection at the site of the vascular puncture.
- Bleeding from a punctured vessel.
- Allergic reactions to contrast or local anesthetic.
- Damage to the vessel at the site of insertion of the catheter.
- Filling the blood clot with a blood clot that covers the lower vena cava, causing swelling in the legs.
- Migration of CF in the heart or pulmonary artery.
- Damage to the wall of the inferior vena cava and adjacent organs.
- The growth of removable filters in the walls of the vessel, because of what it can not be removed.
- Pneumothorax - the presence of air in the pleural cavity. This complication can develop when the cava filter is inserted through the internal jugular vein.
