The procedure for taking and placing the vena cava filter under the background digitizer

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Take and place a vena cava filter under the background digitizer to prevent blood clots from moving to the heart and lungs. This is a relatively safe and highly effective method in the prevention of pulmonary embolism.

1. Overview of vena cava screening and placement under background digitization

Pulmonary embolism or pulmonary infarction is a very dangerous complication that can be fatal for patients with thrombosis in the lower extremities or thrombosis in the pelvis.
Placement of the inferior vena cava filter is a temporary or permanent solution for patients with venous thrombosis of the lower extremities. This is a safe and highly effective method of preventing pulmonary embolism due to migratory thrombus in patients unable to take anticoagulants.
The purpose of mesh placement is to prevent thrombi from moving up the heart chambers and into the pulmonary circulation.
Based on the modality, there are 2 common placement procedures including:
Placement of the inferior vena cava filter through the right internal jugular vein; Placed through the common femoral vein.

2. Indications, contraindications for imaging and placement of vena cava filter under background digitization

Indications:
Absolute indications: Venous thromboembolism (VTE) with repeated recurrence despite active anticoagulation; Risk of VTE after trauma; Large thrombus in the lumen. Relative indications: Indications for surgery for people with thrombosis - venous blood clots; Contraindicated with anticoagulant therapy; Thrombolysis for iliac vena cava thrombosis; Use of drugs with a high risk of causing VTE; There are complications when using anticoagulation therapy; VTE in people with chronic cardiopulmonary disease. Indications for prophylaxis: Unable to continue anticoagulation therapy; Patients who do not comply with anticoagulation therapy; There is a high risk of complications with anticoagulation therapy. Contraindications:
Diseases of the inferior vena cava including: inferior vena cava stenosis due to thrombosis, invasion, compression; Hypoplastic, aplastic inferior vena cava, inferior vena cava > 40mm in diameter. No access: The internal jugular, subclavian, and femoral veins are blocked, or the soft tissue around these veins is inflamed. Uncontrolled blood clotting disorders: Thrombocytopenia bleeding, Hemophilia, clotting factor deficiency. Risk of complications due to contrast: Allergy to iodinated contrast; Kidney failure is progressing; Pregnant. Severe systemic disease: Sepsis.

3. The procedure for taking and placing the vena cava filter under the background digitizer

3.1 Prepare the procedure for taking and placing the vena cava filter under the background digitizer
Performer: Specialist doctor, assistant doctor, radiology technician, nurse. Means: Background erasing digital angiogram (DSA); Dedicated electric pump; Image storage system; X-ray shielding lead vest. Drugs: Local anesthetic; Pre-anesthetic drugs and general anesthesia (if the patient has an indication for anesthesia); Anticoagulants; neutralizing anticoagulants; Iodine contrast is soluble in water and antiseptic solutions. Medical supplies: Syringe 5; ten; 20ml and syringe for electric pump; Distilled water or physiological saline; Gloves, shirt, hat, surgical mask; Aseptic kit includes: Knife, scissors, tongs, metal bowl, bean tray, tool tray; Cotton, gauze, surgical tape; Medicine box and necessary tools for emergency treatment of contrast agents and anesthetics; Needle arterial puncture; Intake kit size 5-6-8F; Standard conductors; Long, stiff conductor; Angiography catheter size 4-5F; Catheter size 6-8F; Specialized venous filter set; Three-pronged lock; Kit for endovascular removal. Patients Patients and family members are carefully explained about the procedure and possible complications to coordinate with the physician; Need to fast, drink before 6 hours. Can drink no more than 50ml of water. In the intervention room: Supine position, breathing monitor, pulse, blood pressure, electrocardiogram, SpO2. Disinfect the skin then cover with sterile gasoline with holes; If the patient is too excited, anxious, unable to lie still: need to give sedation... 3.2 Steps to carry out the procedure to take and place the vena cava filter under digitizer to erase the background
Anesthesia method: Patient Lie on your back on the x-ray table, place an intravenous line. This method usually uses local anesthesia, which can be injected with pre-anesthesia in cases such as young children (under 5 years old) who have no sense of cooperation or are too excited and afraid to need general anesthesia. when doing the trick. Aspiration of the internal jugular vein must be performed under local anesthesia, making incisions in the skin and subcutaneous tissues; Aspiration of the right internal jugular vein under ultrasound guidance. In some cases, it may be necessary to puncture the left internal jugular vein or the femoral vein; Insert the catheter and catheter into the right internal jugular vein under the guidance of an enhanced fluorescein screen. Inferior vena cavitation Insert the catheter into the inferior vena cava at the level of the iliac junction (where the inferior vena cava splits into two iliac veins); Perform inferior vena cava scan, evaluate morphology and hemodynamics of inferior vena cava. Place the mesh strainer into the inferior vena cava Insert the mesh-carrying device into the inferior vena cava through the lumen; Position the filter below the level of the renal veins; Remove the sheath to release the filter into the lumen of the inferior vena cava; Take a picture of the inferior vena cava. 3.3 Evaluate the results after placing the filter
After placement, take an angiogram and evaluate the following factors:
The filter must be located just below the renal veins. The filter axis must be parallel to the axis of the kidney. Inferior vena cava The inferior vena cava circulates normally after mesh placement. There were no signs of vascular wall tear or hematoma, retroperitoneal or abdominal bleeding. 3.4 Complications and measures to manage
Technological complications Hematoma at the venipuncture site: Treat with local compression Bandage infection around the catheter foot: Sanitize, use antibiotics local and whole body; Sepsis: This is a dangerous complication that requires immediate treatment with antibiotics. Complications related to the filter mesh Move: This condition is often caused by the inferior vena cava dilatation too large for the size of the filter. For prevention, it is necessary to choose the correct size of the filter relative to the diameter of the inferior vena cava. When the filter is moved, the filter can be removed if it is found that the filter is not suitable. Broken filter: Because the filter is used many times or because the material of the filter mesh is not guaranteed. Prevent by not reusing the filter mesh. Inferior vena cava tear: Follow-up or surgery according to specialists' opinion.
Pulmonary embolism is a potentially fatal complication. Prevention of pulmonary embolism complications by placing a mesh filter is a commonly used and quite safe measure. If you are at high risk, you should visit your doctor for advice and early treatment. Currently, Vinmec International General Hospital is one of the leading prestigious hospitals in the country, trusted by a large number of patients for medical examination and treatment. Not only the physical system, modern equipment: 6 ultrasound rooms, 4 DR X-ray rooms (1 full-axis machine, 1 light machine, 1 general machine and 1 mammography machine) , 2 DR portable X-ray machines, 2 multi-row CT scanner rooms (1 128 rows and 1 16 arrays), 2 Magnetic resonance imaging rooms (1 3 Tesla and 1 1.5 Tesla), 1 room for 2 levels of interventional angiography and 1 room to measure bone mineral density.... Vinmec is also the place to gather a team of experienced doctors and nurses who will greatly assist in diagnosis and detection. early signs of abnormality in the patient's body. In particular, with a space designed according to 5-star hotel standards, Vinmec ensures to bring the patient the most comfort, friendliness and peace of mind.

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