Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when perfo
CPT4 code
Name of the Procedure:
Repositioning of Intravascular Vena Cava Filter, Endovascular Approach
Common Names: Vena Cava Filter Adjustment, IVC Filter Repositioning
Technical Terms: Endovascular Vena Cava Filter Repositioning
Summary
In layman's terms, this procedure involves adjusting the position of a filter that's placed in a large blood vessel called the vena cava. This filter helps to prevent blood clots from traveling to the lungs, but sometimes it needs to be repositioned for optimal function.
Purpose
The procedure addresses the need to ensure the vena cava filter is correctly positioned to effectively prevent pulmonary embolisms (blood clots in the lungs). The goal is to optimize the filter's placement to prevent complications, improve patient outcomes, and ensure its effectiveness.
Indications
This procedure is indicated for patients who have a vena cava filter that is either incorrectly positioned or has migrated. Symptoms warranting this procedure may include symptoms of potential filter complications such as abdominal pain, chest pain, or leg swelling. It may also be performed as a preventative measure based on radiological findings.
Preparation
- Patients may be advised to fast for a certain period before the procedure.
- Blood tests to check clotting status and kidney function.
- Imaging tests like an ultrasound or CT scan to assess the current position of the filter.
- Adjustment or temporary discontinuation of certain medications like blood thinners.
Procedure Description
- Vascular Access: The patient will be placed under local anesthesia or light sedation. A small incision is made, usually in the groin or neck, to access the blood vessels.
- Vessel Selection: A catheter is inserted into the blood vessel and guided to the location of the vena cava filter.
- Radiological Supervision: Continuous imaging using fluoroscopy and ultrasound ensures precise navigation and positioning.
- Intraprocedural Roadmapping: Real-time imaging helps map out the pathway and position the catheter and other instruments correctly.
- Filter Repositioning: Using specialized tools through the catheter, the filter is carefully moved to the appropriate position.
- Final imaging ensures the filter is correctly placed before the catheter and other instruments are removed.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
Performed in a hospital's interventional radiology suite or a dedicated procedural room equipped for endovascular procedures.
Personnel
- Interventional radiologist or vascular surgeon
- Radiologic technologist
- Nurses specializing in procedural care
- An anesthesiologist or sedation nurse
Risks and Complications
- Bleeding or infection at the incision site
- Blood vessel damage
- Filter migration or failure to reposition
- Blood clots
- Rare complications may include heart or lung injury
Benefits
- Correctly repositioned filter prevents blood clots from traveling to the lungs.
- Immediate improvement in symptoms caused by filter misplacement.
- Longer-term prevention of serious complications like pulmonary embolism.
Recovery
- Patients may need to stay in the hospital for observation for a few hours or overnight.
- Instructions on wound care and activity restrictions will be provided.
- Pain medication may be prescribed if needed.
- Follow-up appointments to monitor the filter position and overall health.
Alternatives
- Removal of the vena cava filter if not necessary or if it causes complications.
- Anticoagulant medication to manage blood clots as a non-surgical option.
- Pros and cons of alternatives depend on patient-specific factors and the risk of pulmonary embolism.
Patient Experience
- During the procedure, patients may feel pressure but should not experience significant pain due to anesthesia/sedation.
- Post-procedure discomfort can be managed with pain relievers.
- Some bruising and soreness at the incision site are common.
- Most patients resume normal activities within a few days, with specific restrictions advised by their healthcare provider.