Complicated Inferior Vena Cava Filter Retrievals: Associated Factors Identified at Preretrieval CT

Abstract

CT appearance of tip embedding, increased tilt angle, higher-grade perforation, and longer dwell times are associated with complicated IVC filter retrieval. Therefore, preretrieval CT may be warranted in select patients for identification of these characteristics to tailor retrieval approach or to arrange a referral to a tertiary center if necessary.

Inferior Vena Cava Filter Removal After Prolonged Dwell Time of 2310 Days

“…Advanced retrieval, generally considered to be safe, is characterized by prolonged fl uoroscopy time, use of nonstandard retrieval techniques and devices, fi lter fracture, fi lter tip embedding in the IVC wall, and retrieval failure ( 6 ). Nonstandard techniques include advanced snare maneuvers, laser-assisted sheath tissue ablation, microdissection with rigid or fl exible forceps, and combinations of these methods.…”

“…Th ese include tilt angle in mediolateral and anteroposterior directions (>15° cutoff ), tip embedding (tightly opposed to IVC wall), strut perforation, and dwell time ( 6 ). Some characteristics are anecdotally related, such as increased tilt angle and tip embedding.…”

“…Some characteristics are anecdotally related, such as increased tilt angle and tip embedding. Th e degree of fi lter strut perforation is based on a grading system: grade 0, all struts confi ned within the lumen; grade 1, strut external but immediately adjacent to the IVC wall; grade 2, struts completely outside IVC lumen; and grade 3, struts adjacent to or inserting into an adjacent organ or retroperitoneal structure ( 6 ). Identifi cation of these factors can aid in procedure planning, proper consent, and referral to a tertiary center if needed.…”

“…Although retrieval success remains high after more than 1 year after implantation (100% in one study), a prolonged dwell time >180 days has a signifi cant increased risk of complicated retrieval (odds ratio, 2.3) ( 6,8 ). Th us, some authors suggest considering preprocedural CT in the setting of prolonged dwell time ( 6 ).…”

Vena cava filters are not superior to low molecular weight heparin in venous thromboembolism prophylaxis: a study on long term immobilized neurosurgical patients

“…There is an increased tendency to use optional filters in recent years since they may be removed percutaneously within the period specified by the manufacturer. Retrieval of IVC filters might be complicated in patients with longer filter indwelling times (9), and IVC penetration of filter struts may prevent successful retrieval 2 weeks after implantation (3). It should be noted that removal might be unsuccessful due to technical problems or the presence of thrombus on the filter itself.…”