• Medications

  • Anesthesia

    • Local anesthetic: 1% lidocaine

    • Conscious sedation: Fentanyl, midazolam

    • General anesthesia (if needed)

  • Prophylactic antibiotics

    • Based to local protocol

  • Management of co-morbidities  (allergy, blood glucose, blood pressure, nausea, etc)

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• Trolley/Equipment​

  • Access micropuncture kit

  • Catheters 

    • Flush and directional catheters

  • IVC Filter retrieval kit

  • Sheaths

    • Short 6Fr

  • Snares

  • Wires 

    • 0.035" standard, hydrophilic, Amplatz superstiff 

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• Checklist

  • CIRSE (IR Patient Safety Checklist)

  • LocSSIPs (Local Safety Standards for Invasive Procedures)

  • NatSSIPs (National Safety Standards for Invasive Procedures)

  • WHO (World Health Organization Surgical Safety Checklist)

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• Access

  • Supine position for transjugular access

    • Check manufacturer’s instructions if transfemoral approach is needed

  • Ultrasound guided is recommended

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• Technique

  • Cleanse the access site and cover with sterile drape

  • Ultrasound guided venous access with seldinger technique

  • Sheath insertion over the wire (Flush the sheath)

  • Catheter and wire negotiated to a common iliac vein under fluoroscopy

  • Exchange the catheter with a diagnostic pigtail catheter

  • Connect the catheter with the contrast injector and perform a venogram in AP view

    • Verify patency of IVC

    • Exclude filter thrombosis

  • Exchange the catheter and sheath with the filter retrieval system, over the wire

  • From the transjugular approach the tip of the retrieval kit is positioned above the filter

  • The retrieval snare is used to grab the filter’s hook

    • If the hook is tilted or embedded in the wall, modified techniques can be used to assist exposure of the hook

      • Sling technique

      • Balloon inflation between the filter and the IVC wall 

      • Amplatz Superstiff wire from the access to the common iliac vein can

  • Secure and hold the hook and simultaneously push the sheath to collapse the filter’s legs

  • When the filter is within the sheath, hold the sheath and remove the filter

  • Perform final venogram from the sheath to exclude complications

  • Remove the sheath

  • Manual compression of the access site for 5’

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• Tips​

  • Ask for the patient to hold breath during venograms

  • Contrast injection: usually 20ml at 15ml/s are satisfactory

 

• Report

  • Describe any pathology noted at the venograms

  • Mention anatomic variations

  • Report the technique

  • Post-procedure instructions if needed

  • Consider a retrieval date if possible