The vena cava filter is a medical device designed to reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism in people with high risk of thrombosis. Let’s learn more about it now.

Here is the content:

• Development history of vena cava filter

• Preparation before placing the vena cava filter

Development history of vena cava filter

(1) The history of heparin therapy can be traced back to 1938. In 1968, it was proposed to use inferior vena cava ligation to solve this problem, in order to prevent thrombus from entering the pulmonary artery. It was not until 1943 that femoral vein ligation was used to clinically prevent pulmonary embolism. This technique still causes 10-26% of patients to have pulmonary artery embolism again due to collateral circulation of lower limbs and pelvic cavity. Another reason for the elimination of this technique is the severe congestion of femoral vein after ligation.

(2) Homans used ligation of inferior vena cava in 1943, which had an obvious disadvantage: It prevented venous blood from returning to the heart and reduced cardiac output. In addition, 7-50% of patients suffered from pulmonary embolism again due to collateral circulation.

(3) At the beginning of the 1960s, various special devices of inferior vena cava appeared to solve this problem, such as Adams-De Wesse clip, which divided inferior vena cava into small venous channels (4 channels with a diameter of 3mm). Although it could reduce pulmonary embolism to 2-4%, the incidence of inferior vena cava embolism and congestion was high (53%), and the complications of surgical placement of this device were high (9-27%).

(4) The development of interventional radiology provides a better method. A kind of Filter can be inserted with minimally invasive non-surgical intubation technology, which not only obviously improves the clinical application effect, but also reduces the trauma.

(5) In 1967, the extension of Mobin-Uddin umbrella filter reduced the incidence of pulmonary embolism to 3%, and the complications caused by the operation of placing the filter were 0%. The main disadvantage was that the patent rate of vena cava was only 36-47%, and 10-75% of patients had edema, ulcer and dermatitis of lower limbs. Therefore, people began to persistently research and develop better vena cava filters.

Preparation before placing the vena cava filter

(1) Before placing the vena cava filters, a complete vena cava angiography must be done, which can not only know the diameter of the inferior vena cava, but also get some important information that was not known before angiography.

(2) There is no special method of venipuncture, except that some patients are difficult to puncture due to vascular obstruction. In some countries, hospitals use ultrasonic Doppler (pen probe) to guide puncture, which can improve the puncture success rate. After a successful puncture, a contrast agent should be injected through the puncture sheath or vascular sheath to show the iliac vein. If there are emboli (filling defects) in the iliac and femoral veins, the jugular vein should be used instead.

(3) During radiography, patients should do Valsalva action, which is beneficial to the accurate measurement of inferior vena cava. If the diameter of blood vessel is larger than that of filter, the filter will be displaced after placement. After the placement of the filter, the vena cava angiography should be repeated, which can be used as data for future comparison to determine whether there is displacement or not.

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