Dr. Frank Lynch discusses IVC filters – Penn State Hershey Medical Center

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.

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