Bidirectional Pull-Back Technique for Retrieval of Strut-Embedded Cylinder-Shaped Filters in Inferior Vena Cava

Abstract

BackgroundIVC filters have been widely accepted as an effective method to prevent pulmonary embolism (PE) in patients with deep venous thrombosis (DVT). However, the placement of IVC filters is associated with significant complications and filter retrieval can be challenging when the filter struts are embedded into the caval wall.Material/MethodsOver 26 months, we reviewed the safety and efficacy of the bidirectional pull-back technique for removing strut-embedded IVC filters in 15 consecutive patients. Retrieval procedural data such as in-dwell time, retrieval time, and fluoroscopy time were recorded. Clinical outcomes and procedure-related complications were evaluated by venography or enhanced computed tomography. Histologic tissue was analyzed to reveal the pathologic effects of chronic filter implantation. All patients underwent routine clinical follow-up at a mean time of 12 months (range, 8–14 months).ResultsTechnical success of filter retrieval was achieved in 100%, with mean implantation of 46.6 days (range, 27–66 days). Filter types were as follows: OptEase (n=11) and Aegisy (n=4). The mean retrieval time and fluoroscopy time were 21.43±5.42 min and 7.63±2.67 min, respectively. Immediate postprocedure venography showed no procedure-related complications. Thirteen patients discontinued previously prescribed lifelong anticoagulation. There were no long-term complications during follow-up.ConclusionsThe bidirectional pull-back technique is safe and efficient for filter retrieval. This complex technique can be particularly useful in selected patients to remove strut-embedded cylindrical-shaped IVC filters previously considered irretrievable.

Inferior vena cava filter retrievals using advanced techniques: a systematic review

“…A dual access bi-snare method was attempted in two cases in which snares approaching from the right internal jugular and common femoral veins provided opposite tractions on embedded filters. 8 , 26 Although Du et al 36 also describe a similar bi-snare technique, the SOGL technique was also used. As a result, these cases were categorized as using a modified loop-snare method.…”

Endovascular retrieval of a fractured Optease inferior vena cava filter using endobronchial forceps and intraoperative cone-beam computed tomography guidance

“…The double guidewire and snare technique uses double venous access (jugular and femoral veins) and can be used when an IVC filter is tilted or embedded into the caval wall. The use of the bidirectional pull-back technique reported by Du et al 3 proved useful for cylindrically shaped embedded IVC filter retrieval. However, in the case of strut fracture, this technique can fail to retrieve the entirety of the filter.…”

“… 1 Removal of IVC filters after their recommended indwelling time using a minimally invasive approach is not without additional risks and requires judicious planning and adoption of advanced endovascular retrieval techniques. 2 , 3 These include conventional computed tomography (CT) venography to understand the IVC filter position and orientation and the presence of any fragmentation and real-time imaging techniques such as two-dimensional angiography and intravascular ultrasound (IVUS). Recently, angiographic imaging systems have evolved to have three-dimensional cone-beam CT (CBCT) capability that creates CT-like cross-sectional images to provide intraprocedural soft tissue imaging and guidance during interventions.…”