What is included in the preprocedure assessment for inferior vena cava (IVC) filter candidates?

Updated: Oct 31, 2020
  • Author: Gary P Siskin, MD; Chief Editor: Kyung J Cho, MD, FACR, FSIR  more...
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Answer

Answer

Candidates for IVC filter placement are typically evaluated for DVT and/or PE. Imaging methods used to document lower-extremity DVT include ultrasonography (US) and peripheral venography. PE is usually diagnosed by nuclear medicine ventilation-perfusion (V/Q) scans.

Although pulmonary arteriography remains the criterion standard for confirmation of diagnosis, an increasing number of centers are using multichannel detector-row helical (MDH) computed tomography (CT) to evaluate patients in whom PE is suspected. Alternatively, magnetic resonance angiography (MRA) of the pulmonary vasculature can also be performed.

Laboratory assessment

Laboratory assessment typically includes the following:

  • Coagulation profile (including platelet count)

  • Prothrombin time (PT)

  • Activated partial thromboplastin time (aPTT)

  • Renal function with serum blood urea nitrogen (BUN) and creatinine levels

If a filter is to be placed in a patient who is receiving anticoagulation therapy, the medications are usually discontinued before the procedure. Discontinuing heparin on call is usually adequate, although some physicians prefer to discontinue heparin for 2-4 hours before the procedure.

Gray et al described the safety of venous interventional procedures, including pulmonary angiography and filter placement, in 100 patients receiving anticoagulation. [103] Of these patients, 87 had prolonged bleeding times. [103]


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