- New clot or clot progression on therapeutic anticoagulation.
- Pre-op for patient who cannot be anticoagulated
- Can be placed from a transjugular or transfemoral approach.
- Ideal location is infra-renal.
- Make sure to check a CT beforehand for variant renal vein anatomy.
- Access the venous system either via a jugular or femoral approach. If femoral, the vein is 1 cm medial to the artery.
- Insert a Pig cava catheter, and perform an angiogram (Usually 15 ccs / min for 30 cvs)
- Exchange the catheter for the filter sheath, after dilation of the tract.
- Gunther-Tulip Jugular
- Insert the filter until the feet are at the end of the sheath. Unsheath the filter. Press the button to deploy.
- Gunther-Tulip Femoral
- Insert the filter until the tip is at the end of the sheet. Unsheath the filter. Bring the red and white torquers together and twist to deploy.
- Make sure the correct end is facing the catheter
- If retrievable, can be retrieved up to 3 weeks before the filter epithelializes
- Complications: fragmentation, migration, perforation