 Is that kind of focus? That's kind of creepy, huh? Welcome back to the channel, everybody. For those of you who are new around here, my name is Michael, aka Dr. Cellini, and I am a radiologist in my sixth and final year of training, subspecializing in interventional radiology in New York City. On today's video, we are going to do something I haven't done in a very long time, which is unbox some medical equipment. Today's piece of medical equipment I use on a daily basis in interventional radiology is found in this little cartridge right here. And you probably have seen by the title and thumbnail of this video that we are going to be unboxing or talking about an IBC filter. And yes, it comes in this little cartridge. I haven't done this style of video in a very long time for a number of reasons. Most importantly, because nobody usually likes it. It gets like no views when I do these educational type videos. But you know what? This has been sitting on my desk for a while now. I've wanted to open it because once you deliver it, you can't put it back in. And I've also wanted to open it so that I can put it on my desk as a nice little like desk ornament or whatnot. So today we're going to push this out and talk about it. Let's go. So the way I'm going to approach this video is I'm going to talk about the indications of an IBC filter or an inferior vena cava filter. Then we'll unbox it or unsheathe it. And then we'll talk about the complications and then that'd be pretty much it. So let's first get into the indications of putting an IBC filter in. And the first indication is someone with an acute DBT or deep vein thrombosis that cannot be anti-coagulated with blood thinners. Some of those reasons may be a recent surgery or a recent neurosurgery or a recent bleed in the brain or bleed in the retroperitoneum or whatnot. Those are all contraindications to anti-coagulation in someone who has a DBT. The main goal of having this IBC filter in the IBC or inferior vena cava is to provide a filter of all of the blood coming from your lower extremities and pelvis up to the heart and ultimately to the lungs, which prevents clot from going all the way up into your lungs, also known as a pulmonary embolism. And if you don't know what a pulmonary embolism is, I did an entire video I'll link up here where I actually went over a CT scan imaging that showed thrombus or DBTs in the lower extremities and an IBC filter and a pulmonary embolism. So go check that video out after this one, of course. Another indication of placing an IBC filter would be someone who has been on anti-coagulation or blood thinners and they failed anti-coagulation, which means maybe they had a DBT in their right leg. They were put on blood thinners and developed another thrombus on top of that. That would be evidence of failure of anti-coagulation. And for that instance, putting them on a blood thinner again probably won't do anything. So you need to place an IBC filter to prevent that from going up to the lungs. Another indication I see a lot is someone who has a massive PE or a massive pulmonary embolism and we treat them with thrombectomy or surgical embolectomy. In that instance, we would place an IBC filter after the procedure to prevent further migration of clot in the lower extremities from going up to the lungs and repeating that whole process, especially in a human dynamically unstable patients. So these are just three of the most common indications I see when placing these. Now let's get to the important part of the video, which is where I uncheat this IBC filter. All right, so now let's get to the unsheathing of this actual IBC filter. What we've all been waiting for, including myself, I've had this sitting on my desk for like probably four or five months now. You may or may have not noticed it sitting there. I've been debating whether or not to do this video. But anyways, we're here. Let's go ahead and unsheathe it. If you see on this actual filter, I'll try to show you. So there's a jugular side and then if you flip it around, there's a femoral side. So what that means is you place it this way if you were going to do a jugular approach. So like this, we put it in the sheet this way. If you were doing a femoral approach, you'd have the arrow pointing this way. And the reason being is because the filter is going to be in the same position regardless, you just need to expose it in the sheet the correct orientation because you don't want an upside down filter because you placed it in the wrong direction. That'd be very bad for him. So let's go ahead and open this thing. Let's do the jugular form because I usually do a jugular approach. So I access the jugular vein, usually the right jugular vein, put a long sheath down and then we put this through the sheath. It clicks in on this side. And then what it will do, see if I can do this on the camera here, is you kind of gently push this out, or I'll try to push it out to get it started here. So you can actually see the legs coming out right there. And I don't have a wire to push the rest of this out. So what I'm going to do is just kind of grab it. So imagine me pushing a wire this way and I load it into the sheath. I put this in the neck right here and the sheath in the neck. And then this is actually going down a very long tube. That's about right where I want it, just below the renal veins. And what happens is you push a wire out and eventually this thing will come out. You can see it start to expose itself right there. And then eventually you have your cute little IVC filter right here. And this is a very smushed one. So I'll try to expand it a little bit so you can see it. So I believe this is made out of nightnall, which is a very thin malleable metal. And it actually expands to the vessel as the body kind of warms it up. So this sits just like this in the inferior vena cava and in this orientation. So any blood coming up this way gets filtered by the IVC filter. So you can see how if there was a clot that was traveling up the IVC, it would get stuck in this metal right here and not be able to go to the heart and to the lungs. This is an option elite filter I believe by Argonne Medical, no sponsor whatsoever. These are just the filters we use. We used a Denali filter in North Carolina where it came from. So a couple of things about this filter. These tines, hopefully you guys can see these tines here. They're actually very sharp on the edge. And when you pull these out, these can actually cut you. So you have to be very careful when you pull them out of a patient because you don't wanna get, it's like getting stuck with a needle. The other thing too is you can notice there is a hook on the top of this filter. If you can see that right there. That little hook is actually what we lasso when we take it out. After this has done its job, you should remove it because this is a retrievable filter. And the way we do that is the exact same way we put it in, but we just basically lasso it with a loop snare or some type of snare. We hook this hook, put a sheath over it and we can actually just pull it out. And it's all good. It's all done. You'll notice once you pull these out, they're usually a lot wider because the body temperature, they're usually about like that. So the body temperature kind of warms it up and it expands to fit the vein. So yeah, that's the IBC filter. So complications of this procedure or placing an IBC filter. First and foremost, bleeding is always a risk factor when doing any procedure because the way we place these is we access the main vein in the neck, the internal jugular vein or the femoral vein in the groin. We grow up and we place these and there can always be a bleeding complication when you place at least a larger sheath within to the jugular vein or femoral vein. You can always have a bleeding complication. Another complication you may have is infection. This is a foreign body we're placing within the main vein of the body. Yes, this could be infected because the body doesn't necessarily love foreign objects. You could also have damage of the actual inferior vena cava or the main blood vessel from this filter. The filter has very pointy tines that can kind of stick out and cause issues in the actual vessel itself, especially if left in for a very long period of time. So that can be a complication as well. Another complication I have seen in the past is filter migration. What that means is the filter traveling somewhere else other than where we put it or other than where we intended to place it. I have seen these all over the place. Most of the time they stay still because they have those pointy tines on them, but I've seen them migrate to the heart. I've seen them migrate into renal veins, blocking off the vein and the kidney. I've seen them go all over the place. And that's especially true when we are removing these when some of these tines can actually break apart, dislodge and travel back to the heart or wherever they want to. Another ironic complication of having one of these IVC filters in place is thrombosis of the actual filter itself. So if it does its job and catches a clot that would have gone to the lungs, it can thrombose itself and make it very challenging for removal. And usually we do not remove these if they have thrombus around them because it causes more of a challenge and they're doing their job and you don't want to remove that filter and have that thrombus go up to the lungs after you remove it. So it's almost like a catch 22. And this is the reason when we remove these filters we always do a vinaigram to see if there's any thrombus associated with the actual filter itself. Because if there is, we won't remove it. We'll likely anticoagulate them if we can or we'll try to suck out that thrombus before we remove the filter. The real question I have for you all is how can I put this in like some sort of like gelatin mold or something to make a paperweight for my desk? That's the real question I have for you all. If you know that, let me know in the comments below. If you have any other questions, let me know in the comments below. I'll be happy to answer them. As always, make sure you smash that like subscribe button. If you like this kind of video, let me know because usually it gets like 10 views and I'm just doing it for the heck of it. I don't even know why. Make sure you follow me on Instagram and TikTok and I guess I'll see you all on the next video. See ya.