Suprarenal Inferior Vena Cava Filter Placement

A suprarenal position for an inferior vena cava filter may not always represent a complication. In fact, suprarenal filter placement may be indicated when the traditional infrarenal position may be dangerous or impossible. A suprarenal inferior vena cava filter may be indicated in the following settings:

• Narrowed infrarenal vena cava: Can be due to intrinsic (e.g., thrombosis, congenital) or extrinsic (e.g., compression) factors.
• Thrombosis above the level of the renal veins: These thrombi render an infrarenal filter useless in preventing pulmonary emboli.
• Renal or gonadal vein thrombosis: These thrombi can bypass an infrarenal filter to embolize to the lungs.
• Pregnancy: The theory is that the gravid uterus can compress the infrarenal inferior vena cava and filter, leading to complications such as injury to the uterus, inferior vena cava, or the filter itself.

The risk of filter migration may be higher due to the the larger diameter of the suprarenal inferior vena cava and its variability due to venous return, blood volume, and the respiratory cycle. Renal failure has also been reported with suprarenal filter placement. Long-term follow-up of patients with suprarenal filters, however, has found that their efficacy and safety are comparable to those of infrarenal filters.

References

• Ganguli S, Tham JC, Komlos F, Rabkin DJ. Fracture and migration of a suprarenal inferior vena cava filter in a pregnant patient. J Vasc Interv Radiol. 2006 Oct;17(10):1707-11.
• Greenfield LJ, Proctor MC. Suprarenal filter placement. J Vasc Surg. 1998 Sep;28(3):432-8.
• Kalva SP, Chlapoutaki C, Wicky S, Greenfield AJ, Waltman AC, Athanasoulis CA. Suprarenal inferior vena cava filters: a 20-year single-center experience. J Vasc Interv Radiol. 2008 Jul;19(7):1041-7.