A single center experience with retrievable IVC filters

Renno, Anas; Khateeb, Faisal; Kazan, Viviane; Qu, Weikai; Gollapudi, Anurekha; Aplin, Brett; Abbas, Jihad; Zelenock, Gerald B.; Nazzal, Munier

doi:10.1177/1708538114546713

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…This study is the first report from Asia to investigate the indications of IVC filter insertion, filter retrieval rate, and predictors of filter retrieval. We found that attempts at filter retrieval were made in 44.9% of the cases, a rate that is slightly higher than those previously reported elsewhere, 7,14–16 but that remains lower than desirable. Many of the patients with retained filters seemed to be eligible for filter retrieval, as they were receiving anticoagulant therapy.…”

Section: Discussioncontrasting

confidence: 65%

Practice patterns of retrievable inferior vena cava filters and predictors of filter retrieval in patients with pulmonary embolism

Kang

Shin

et al. 2017

Vasc Med

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Retrievable inferior vena cava (IVC) filters are increasingly used in patients with venous thromboembolism (VTE) who have contraindications to anticoagulant therapy. However, previous studies have shown that many retrievable filters are left permanently in patients. This study aimed to identify the common indications for IVC filter insertion, the filter retrieval rate, and the predictive factors for filter retrieval attempts. To this end, a retrospective cohort study was performed at a tertiary care center in South Korea between January 2010 and May 2016. Electronic medical charts were reviewed for patients with pulmonary embolism (PE) who underwent IVC filter insertion. A total of 439 cases were reviewed. The most common indication for filter insertion was a preoperative/procedural aim, followed by extensive iliofemoral deep vein thrombosis (DVT). Retrieval of the IVC filter was attempted in 44.9% of patients. The retrieval success rate was 93.9%. History of cerebral hemorrhage, malignancy, and admission to a nonsurgical department were the significant predictive factors of a lower retrieval attempt rate in multivariate analysis. With the increased use of IVC filters, more issues should be addressed before placing a filter and physicians should attempt to improve the filter retrieval rate.

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Section: Discussioncontrasting

confidence: 65%

Practice patterns of retrievable inferior vena cava filters and predictors of filter retrieval in patients with pulmonary embolism

Kang

Shin

et al. 2017

Vasc Med

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“…In fact, many studies have found that the factor most associated with failed IVCF retrieval using standard techniques is filter tilt. [6][7][8] Although advanced retrieval techniques have higher success rates of up to 95%, severe tilt is also a leading factor associated with major complications during advanced techniques, including IVC dissection, IVC thrombus/stenosis, filter fracture with embedded strut, IVC injury with hemorrhage, and vascular injury from complicated venous access. Severe filter tilt can be managed with retrieval and replacement, but the process of having to retrieve and replace the existing filter is itself associated with procedural risks and longer radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] At more than 15 degrees, filter tilting may lead to reduced efficacy of the filter in preventing pulmonary embolism (PE) and reduced success rate of retrieving the filter once it is no longer indicated. 2,3,6 Severe tilting leads to compromise of the conical design, and the larger resulting openings for passage of clot increases the risk of significant PE. Deviation of the filter hook away from the IVC midline can also cause difficulties in removing the filter using standard techniques, especially if the hook is against the caval wall.…”

Section: Introductionmentioning

confidence: 99%

A New Catheter Technique to Correct Severe IVC Filter Tilt during Placement

Laroia

Guan

Laroia

et al. 2019

J Clin Interv Radiol ISVIR

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Introduction Inferior vena cava (IVC) filter tilt is a common complication that occurs during and after filter placement. Severe tilting leads to reduced filter efficacy, lower retrieval success, and higher complication rates during retrieval. We present a novel catheter technique to correct severely tilted cone-shaped IVC filters without having to retrieve and replace the existing filter. Methods A retrospective review was performed for patients at our institution over three years who had severely tilted filters and underwent correction with the catheter technique. Indications for filter placement were categorized, and patient age, gender, tilt correction outcome, and complication rates were collected and analyzed. After severe tilting was noted on post-IVC filter deployment venogram, a Sos catheter was passed via the same femoral access site used for the filter placement. The catheter tip was reformed inside the cone of the filter and was used to push the filter tip back toward midline. Completion venogram was taken to document the amelioration of the tilt. Results Out of 28 patients who were found to have severely tilted filters on deployment and underwent correction with the catheter technique, 27/28 (96.4%) had successful correction. One (3.6%) had a minor complication where the filter struts became entangled with the catheter tip; however, simple maneuvering of the catheter and use of a stiff wire to straighten the catheter loop freed up the entanglement. No major complications occurred. Conclusion This technique is safe, effective, obviates filter replacement, and can be considered an additional management option for severe IVC filter tilt during placement.

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“…In addition to their complication rates, little evidence exists to show that temporary IVC filters are being retrieved routinely. Although a single-center review of the filter retrieval reported a 90.6% success rate, 14 this retrieval rate is not achieved uniformly. Most estimates of temporary IVC filter retrieval hover around 20%, whereas a systematic review found an average retrieval rate of 34%, 15 leaving these patients at risk for late complications, and worse, most of these patients likely become lost to follow-up.…”

Section: The Prevention Du Risque D'embolie Pulmonaire Parmentioning

confidence: 95%

Temporary Inferior Vena Cava Filters

Arous

Messina

2016

Chest

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Despite their widespread use, the indications for the selective use of temporary inferior vena cava (IVC) filters remains uncertain with few trials supporting their use. Additionally, the risks of long-term temporary IVC filter insertion are being increasingly discussed amongst the mainstream media and through multiple class action lawsuits. Retrievable IVC filters were specifically designed to have a less secure implantation in order to facilitate retrieval. However, multiple reports have demonstrated significant filter-related complications, most commonly related to duration of implantation. Furthermore, the risk is not isolated to one manufacturer alone. The incidence of filter-related complications is linearly related to its duration of time on the market. Currently, the FDA recommends that IVC filters be removed within 25-54 days of their implantation. Unfortunately, little evidence exists to show that this recommendation is followed routinely. Recently, the PRESERVE Trial (NCT02381509) was initiated as a multicenter non-randomized open label study to determine the safety and effectiveness of commercially available IVC filters (both temporary and permanent) in individuals who require mechanical prophylaxis against pulmonary embolism. Until such evidence is developed, temporary IVC filters should be implanted based on best available evidence and routinely removed within the guidelines of the FDA of 25-54 days. A fair question at this point is whether the design features themselves that are required to manufacture a low profile removable IVC filter can achieve effective prophylaxis against pulmonary embolism at a low rate of short and long-term complications.

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A single center experience with retrievable IVC filters

Abstract: Our study showed that a variety of IVC filters can be retrieved successfully with minimal complication rates. In more than half of our patients, IVC filters were used as permanent. Failure of retrieval was most frequently due to filter tilting.

Cited by 6 publications

References 23 publications

Practice patterns of retrievable inferior vena cava filters and predictors of filter retrieval in patients with pulmonary embolism

Practice patterns of retrievable inferior vena cava filters and predictors of filter retrieval in patients with pulmonary embolism

A New Catheter Technique to Correct Severe IVC Filter Tilt during Placement

Temporary Inferior Vena Cava Filters

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