Insertion 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 performed
CPT4 code
Name of the Procedure:
Insertion of Intravascular Vena Cava Filter (Endovascular Approach)
Summary
This procedure involves placing a small, cone-shaped device called a vena cava filter into the large vein known as the inferior vena cava, which carries deoxygenated blood from the lower body back to the heart. The insertion is done through a minimally invasive technique using vascular access and imaging guidance.
Purpose
The procedure aims to prevent pulmonary embolism (a blood clot blocking a lung artery) by trapping large blood clots that travel from the legs and pelvic veins before they reach the lungs.
Indications
- Deep Vein Thrombosis (DVT)
- Pulmonary Embolism (PE)
- Patients unable to take anticoagulant medications
- Recurrent blood clots despite anticoagulation therapy
Preparation
- Patients are typically instructed to fast for several hours before the procedure.
- Adjustments to medications, especially blood thinners, may be required.
- Pre-procedure imaging tests like ultrasound or CT scans to map out vein structures.
Procedure Description
- Vascular Access: A small incision is made in a vein in the neck or groin area.
- Vessel Selection: A special catheter is guided through the bloodstream to the inferior vena cava.
- Imaging Guidance: Using ultrasound and fluoroscopy, the exact location for filter placement is identified.
- Filter Deployment: The vena cava filter is released from the catheter into the vein, where it expands and attaches to the vessel walls.
- Radiological Supervision and Interpretation: Real-time imaging ensures the filter is correctly positioned.
Anesthesia: Local anesthesia is typically used to numb the access site, along with mild sedation to keep the patient comfortable.
Duration
The procedure usually takes about 1 to 2 hours.
Setting
The procedure is generally performed in a hospital's interventional radiology suite or catheterization lab.
Personnel
- Interventional Radiologist or Vascular Surgeon
- Radiology Technician
- Nurse
- Anesthesiologist (if moderate sedation is needed)
Risks and Complications
- Infection at the insertion site
- Bleeding or bruising
- Injury to blood vessels
- Misplacement or migration of the filter
- Blood clots forming on the filter
- Rare chance of filter fracture
Benefits
- Immediate protection against pulmonary embolism
- Minimally invasive with a relatively quick recovery time
- Can be a lifesaving option for patients who cannot take blood thinners
Recovery
- Observation for a few hours after the procedure.
- Patients might experience mild pain or bruising at the insertion site.
- Follow-up imaging to check filter position and function.
- Normal activities can often be resumed within a day or two.
Alternatives
- Anticoagulant medications (blood thinners)
- Compression stockings to prevent clots
- Regular exercise and lifestyle changes
- Surgical embolectomy for severe cases
Patient Experience
Patients will feel a minimal pinch during the local anesthesia injection. The rest of the procedure should be painless, though sensations of pressure might be felt. Post-procedure, there might be mild discomfort at the insertion site, managed with over-the-counter pain relief.