Puncture of the right internal jugular vein or common femoral vein is performed to obtain access to the IVC. A catheter is advanced to the proximal IVC and a cavagram is performed (Fig. 6.30) to assess the level of the renal veins, accessory renal veins and possible caval abnormalities. The diameter of the cava is measured as dilation can predispose to caval filter migration. The dilivery system is introduced via a sheath to a level just 294 below the renal veins or accessory renal veins, if present. The filter is

Table 6.6 Complications of IVC filters

■ Misplacement of filter

■ Migration of filter

■ Caval penetration

■ Filter embolisation

■ Caval occlusion

deployed at this level after carefully confirming the position relative to the renal veins. Early morbidity is associated with incorrect positioning, above the renal veins or following migration (Table 6.6). Different types of filter exist such as Bird's Nest filter or Greenfield filters. Some removable filters now exist (Fig. 6.31) but caution needs to be exercised in the young adult or paediatric population. 295

Fig. 6.31 Removable IVC filter.

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