Retrieval (removal) 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
CPT4 code
Name of the Procedure:
Retrieval of Intravascular Vena Cava Filter, Endovascular Approach
Summary
This procedure involves the removal of a vena cava filter, a small device that temporarily traps blood clots and prevents them from traveling to the lungs. The filter is removed through a vein using a minimally invasive technique, with the help of imaging technologies for precise execution.
Purpose
The procedure is designed to address issues related to blood clot prevention, specifically in patients who no longer need a vena cava filter. The goal is to safely retrieve the filter to minimize long-term complications and avoid issues such as filter migration, fracture, or perforation.
Indications
- Patients who had a temporary vena cava filter placed to prevent pulmonary embolism.
- Individuals showing signs of filter-related complications.
- Patients whose risk of blood clots has significantly decreased or resolved.
Preparation
- Patients may be required to fast for a specified period before the procedure.
- Blood tests and imaging studies (e.g., ultrasound, CT scan) to assess filter location and surrounding anatomy.
- Discontinuation of certain medications, such as blood thinners, as advised by the physician.
Procedure Description
- Vascular Access: Entry is typically made via a large vein in the neck (jugular vein) or groin (femoral vein).
- Vessel Selection and Imaging: A guidewire and catheter are introduced to navigate to the filter site under ultrasound and fluoroscopy guidance.
- Filter Retrieval: Using specialized retrieval tools, the filter is securely grasped and withdrawn into the catheter sheath.
- Radiological Supervision and Interpretation: Continuous imaging ensures accurate placement and removal of instruments, preventing complications.
- Intraprocedural Roadmapping: Detailed imaging maps the anatomy for precise maneuvering.
Duration
The procedure usually takes 1 to 2 hours.
Setting
Typically performed in a hospital's radiology or interventional suite, occasionally in an outpatient surgical center.
Personnel
- Interventional radiologist or vascular surgeon
- Radiology technologist
- Nursing staff
- Anesthesiologist or sedation specialist
Risks and Complications
- Bleeding at the access site
- Infection
- Venous injury or damage to the vena cava
- Filter fragments left behind
- Blood clots forming at the site of the removed filter
- Allergic reaction to contrast dye
Benefits
- Removal of the filter eliminates the risk of filter-related complications.
- Reduces potential long-term risks such as filter migration or occlusion.
- Typically improves overall vascular health and function.
Recovery
- Monitoring in a recovery area until the anesthesia or sedation wears off.
- Instructions to avoid strenuous activities for a few days.
- Scheduled follow-up appointments to check for any complications.
- Patients can typically return to normal activities within a week.
Alternatives
- Leaving the filter in place with continued monitoring.
- Medical management with anticoagulant therapy.
- Surgical removal if endovascular approach is not feasible.
Patient Experience
During the procedure, the patient will be sedated and should not feel pain. Some pressure or minor discomfort at the access site is possible. Post-procedure, mild soreness, bruising, or swelling at the entry point can occur, typically managed with over-the-counter pain relievers and rest.