American College of Radiology
ACR Appropriateness Criteria®

Radiologic Management of Inferior Vena Cava Filters

Variant 1: Acute pulmonary embolism with negative lower-extremity Doppler ultrasound.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation Usually appropriate N/A N/A 9 n/a 0 0 0 0 0 0 0 0 0
Permanent IVC filter May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Retrievable IVC filter May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Observation/conservative management Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Variant 2: Acute pulmonary embolism and/or iliofemoral deep-vein thrombosis.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation Usually appropriate N/A N/A 9 n/a 0 0 0 0 0 0 0 0 0
Permanent IVC filter May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Retrievable IVC filter May be appropriate N/A N/A 6 n/a 0 0 0 0 0 0 0 0 0
Observation/conservative management Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Variant 3: Symptomatic chronic pulmonary embolism.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation Usually appropriate N/A N/A 9 n/a 0 0 0 0 0 0 0 0 0
Permanent IVC filter May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Retrievable IVC filter May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Pulmonary thromboendarterectomy Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Observation/conservative management Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Variant 4: Calf deep-vein thrombosis.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Permanent IVC filter Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Retrievable IVC filter Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
Observation/conservative management May be appropriate N/A N/A 6 n/a 0 0 0 0 0 0 0 0 0
Variant 5: Prophylactic IVC filter placement in high-risk patients without documented deep-vein thrombosis/pulmonary embolism.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Permanent IVC filter Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Retrievable IVC filter May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Observation/conservative management May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Intermittent pneumatic compression devices Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Surveillance US for deep vein thrombosis May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Variant 6: Phelgmasia cerulea dolens undergoing endovascular treatment.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation Usually appropriate N/A N/A 9 n/a 0 0 0 0 0 0 0 0 0
Permanent IVC filter May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Retrievable IVC filter May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Observation/conservative management Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Variant 7: Upper-extremity deep-vein thrombosis.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Observation/conservative management Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Permanent SVC filter Usually not appropriate N/A N/A 3 n/a 0 0 0 0 0 0 0 0 0
Retrievable SVC filter May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Variant 8: Free-floating iliofemoral thrombus.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Anticoagulation Usually appropriate N/A N/A 9 n/a 0 0 0 0 0 0 0 0 0
Permanent IVC filter May be appropriate N/A N/A 6 n/a 0 0 0 0 0 0 0 0 0
Retrievable IVC filter Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
Observation/conservative management Usually not appropriate N/A N/A 1 n/a 0 0 0 0 0 0 0 0 0
Endovascular therapy May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Variant 9: Retrieval of a filter placed for prophylaxis.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Automatically schedule for retrieval consultation at time of placement Usually appropriate N/A N/A 9 n/a 0 0 0 0 0 0 0 0 0
Clinic visit prior to retrieval Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Duplex of the lower extremities prior to retrieval May be appropriate N/A N/A 6 n/a 0 0 0 0 0 0 0 0 0
CT venogram prior to retrieval Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
KUB prior to retrieval Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Variant 10: Retrieval of a filter placed for deep-vein thrombosis/pulmonary embolism. Patient is now anticoagulated.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Retrieve filter with patient anticoagulated Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Clinic visit prior to retrieval Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Duplex of the lower extremities prior to retrieval Usually appropriate N/A N/A 7 n/a 0 0 0 0 0 0 0 0 0
CT venogram prior to retrieval Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
KUB prior to retrieval Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Reverse anticoagulation prior to retrieval Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Variant 11: Failed first retrieval attempt.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Consider the filter permanent with scheduled follow-up (imaging, clinic visit, operator choice) May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Consider the filter permanent without any follow-up May be appropriate N/A N/A 4 n/a 0 0 0 0 0 0 0 0 0
Consider the filter permanent with lifelong anticoagulation May be appropriate N/A N/A 5 n/a 0 0 0 0 0 0 0 0 0
Re-attempt retrieval with more aggressive measures Usually appropriate N/A N/A 8 n/a 0 0 0 0 0 0 0 0 0
Refer for surgical evaluation for surgical retrieval Usually not appropriate N/A N/A 2 n/a 0 0 0 0 0 0 0 0 0
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.