Inferior vena cava filters have supplanted surgical interruption of the vena cava in the prevention of venous thrombotic embolic events. The ease of implantation has resulted in an increase and varied use despite very specific role they play in the management of patients with venous thromboembolic (VTE) disease. At present, the only absolute indications for placement include patient populations with (1) the development of a pulmonary embolus (PE) while on therapeutic anticoagulation and (2) an absolute contraindication to anticoagulation in patients with deep venous thrombosis (DVT). Relative indications include prophylaxis in patient who cannot be anticoagulated but are at high risk for DVT and those patients who have had a PE with continued residual DVT and may not tolerate another PE event. It is important to note that IVC filters may reduce episodes of pulmonary embolism, but have not been shown to reduce mortality. Long term, IVC filters are associated with an increased risk of lower extremity venous insufficiency. Other complications of IVC filters include migration, perforation of the vena cava or bowel, and complete thrombosis.

The two preferred routes of access are a right transfemoral venous approach and right transjugular venous approach. Alternative access sites include the left femoral and jugular veins and the left or right subclavian veins. Fluoroscopic guidance is the primary method used and will be the primary focus of this chapter. Both transabdominal and intravascular ultrasound have been used to guide successful placement of IVC filters. A brief discussion of suprarenal filters, congenital venous anomalies, and other special situations are also included in this text.