Practical points on transvenous insertion of inferior vena cava filters

During the transvenous insertion of Kimray-Greenfield (KG) and Mobin-Uddin (MU) inferior vena cava filters at the Massachusetts General Hospital, several problems have been encountered and successfully resolved. The author offers suggestions for dealing with small or spastic internal jugular veins, prominent eustachian valves (valves of the inferior vena cava), congenital variations in the inferior vena cava, inferior vena cava thrombi, and filters that have been placed too low or too high. In addition, methods are described for directing the KG filter with gravity, identifying the lowest renal vein with a selective catheter, inserting the KG filter from a femoral venous route, assuring proper seating of an MU filter, and confirming filter position following placement.