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An IVC filter is a device that's placed in the main vein in the abdomen of patients.
And it's designed to capture blood clots that might form in the legs or pelvis.
Normally patients are treated with blood thinners to help prevent those blood clots from growing
and to allow the body to absorb those.
But in patients who can't get blood thinners we install an IVC filter to capture those
clots so they can't break off and migrate to the lungs.
When that does happen that can be a life-ending event. So it's why we use filters as an alternative
to blood thinners.
IVC filters have been around since the '60s and originally they were all permanent devices
so once they were placed they were there for the duration of the patient's life.
That worked well for elderly patients or patients who had diseases that limited their lifespan,
but it became fairly quickly acknowledged that over long periods of time these devices
had problems of their own.
And because of those complications around 1999 a whole new generation of filters that
were designed so that they could be removed.
And the idea being we place a device during a period of high risk for a patient and once
the risk was gone or once they could get standard therapy you could take the device out to prevent
them from having long-term complications.
Well, with our experience with permanent filters we discovered that there are several problems
that can result from leaving an IVC filter in for a long period of time.
The main problem is that the filter itself may start to accumulate blood clot and actually
completely include the blood vessel that it's in.
When that happens that can cause recurrent blood clot in the legs, swelling, ulcerations,
pain which can be quite debilitating for patients.
That's the main reason why filters have now become designed so that they can be removed
to prevent that long-term problem.
But there are other mechanical problems that can be related to the device as well.
They're manmade and the metals that they are made out of sometimes can fatigue and fracture
and as a result the filter - either all or parts of it - can migrate to other parts of
the body or they can poke through the blood vessel wall and injure organs that are in
the neighborhood to where it was implanted.
There is a common misconception that there are relatively short time limits after which
these devices can only be removed.
And while that was originally thought to be the case when these devices first became available,
that's no longer thought to be the case.
And my personal opinion for most devices there's no time limit after which it can't be removed.
And I've taken some devices out that have been in place in excess of five years, sometimes
over eight years without difficulty.
The primary barrier to removing a filter is not being able to grab on to the top of it,
because the filter is tilted in such a way that the top of it came in contact with the
blood vessel wall and the body covered it over so it's not immediately accessible to
someone to grab onto.
Most of the techniques that are advanced techniques that are used for taking filters out are directed
at solving that problem.
And using a variety of devices, catheters and wires we've devised several ways that
we can use to free up the apex of the filter that -- the part that needs to be grab for
it to be removed and allow for removal.
Well, for any patient who has been told that they no longer need their IVC filter, but
has gone through a failed attempt to have it removed we strongly encourage them to seek
a second opinion, you know, particularly a center where they do a high volume of procedures
related to inferior vena cava filter removals.
There are a lot of advanced techniques out there, but there are a lot of people who are
experienced or skilled in their use so.
Well, I tell most patient who seek my counsel is that they should never take no for an answer,
they should always look for another opinion and seek people out who are familiar with
all these devices and the techniques that are used to remove them.