• Indications​

  • Prophylactic:

    • High risk surgical procedures

    • Intracranial haemorrhage

    • Multitrauma patients

  • Venous thromboembolism with contraindication to anticoagulation due to: 

    • Active bleeding

    • Coagulopathy

    • Hemorrhagic stroke 

    • Intracranial neoplasm

    • Previous complication to anticoagulation

    • Recent major surgery

    • Recurrent thromboembolism after anticoagulation 

 

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• Contraindications​

  • Bacteraemia

  • IVC occlusion

  • Lack of venous access

  • Severe allergy to iv contrast

  • Severe coagulopathy

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• Medical History

  • Check

    • Clinical history

      • Symptoms

      • Pathology 

      • Cause

      • Previous surgery?

      • Venous patency?

    • Physical examination 

    • ​Procedure indications

    • Current medications

      • Any anticoagulant or antiplatelet agents?

    • Allergies

    • Ask For:

      • Written/electronic request for the procedure

      • Is the patient capable to consent?

      • Available venous access?

      • Ask for anesthetic team cover if needed

      • Nil by mouth for 6hr prior to the procedure

  • Imaging Studies

    • CTA/CTV, MRV, US

      • Identify the pathology

      • Safe access? 

      • Check vascular anatomy

        • Assess IVC size, megacava?

        • Level of renal arteries

    • Ask For:

      • New imaging if needed

  • Laboratory Exams

    • INR (<2.0), PT, aPTT, PLT (>50.000/μL), Htc, HB, WBC, CRP

    • Infectious Status

    • Ask For:

      • Manage anticoagulation (if needed)

      • Optimize blood products (if needed)

  • Medications​

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

    • Ask For:​

      • LMW heparin: Withhold one dose before the procedure

      • iv heparin: stop 1 hour before the procedure

 

 

• Outcomes

  • Technical success rate: >90%

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• Alternative Treatments

  • Systemic anticoagulation to treat thromboembolism

  • Surgical ligation of IVC