Embedded Inferior Vena Cava Filter Removal: Use of Endobronchial Forceps

Stavropoulos, S. William; Dixon, Robert G.; Burke, Charles T.; Stavas, Joseph M.; Shah, Anand; Shlansky-Goldberg, Richard D.; Trerotola, Scott O.

doi:10.1016/j.jvir.2008.04.012

Cited by 103 publications

(62 citation statements)

References 22 publications

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“…The success rate for removing tip-embedded IVC filters on an intention-to-treat basis was reported to be 96%. Stavropoulos et al later concluded that this endobronchial forceps technique could be safely used to successfully remove embedded filters (21,22). In this technique a rigid endobronchial forceps is introduced through a large caliber venous access sheath (14)(15)(16)(17)(18) and is used to dissect the hook of the IVC filter free from the caval wall.…”

Section: Dissection Techniques Endobronchial Forceps Dissection and Rmentioning

confidence: 99%

“…Additionally the filter may be inadvertently fractured when using the endobronchial forceps so that multiple components of the filter must be individually removed (Figures 9,10) (21-23). The latter technique is suggested by Stavropoulos et al in cases in which over-sheathing of filter is not possible (21,22). Avery et al further suggested that dissection using an endobronchial forceps for filter retrieval could be less costly and more effective and might also be used for standard filter removals (24).…”

Section: Dissection Techniques Endobronchial Forceps Dissection and Rmentioning

confidence: 99%

“…Avery et al further suggested that dissection using an endobronchial forceps for filter retrieval could be less costly and more effective and might also be used for standard filter removals (24). However Stavropoulos described this technique as fairly aggressive and noted that with excessive traction fractured filter components may embolize to the cardiac chambers and or pulmonary arteries thereby requiring aggressive foreign body retrieval and potentially even necessitating surgical removal (22)(23)(24).…”

Section: Dissection Techniques Endobronchial Forceps Dissection and Rmentioning

confidence: 99%

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Inferior vena cava filter retrievals, standard and novel techniques

Kuyumcu¹,

Walker²

2016

Cardiovasc. Diagn. Ther.

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Abstract:The placement of an inferior vena cava (IVC) filter is a well-established management strategy for patients with venous thromboembolism (VTE) disease in whom anticoagulant therapy is either contraindicated or has failed. IVC filters may also be placed for VTE prophylaxis in certain circumstances.There has been a tremendous growth in placement of retrievable IVC filters in the past decade yet the majority of the devices are not removed. Unretrieved IVC filters have several well-known complications that increase in frequency as the filter dwell time increases. These complications include caval wall penetration, filter fracture or migration, caval thrombosis and an increased risk for lower extremity deep vein thrombosis (DVT). Difficulty is sometimes encountered when attempting to retrieve indwelling filters, mainly because of either abnormal filter positioning or endothelization of filter components that are in contact with the IVC wall, thereby causing the filter to become embedded. The length of time that a filter remains indwelling also impacts the retrieval rate, as increased dwell times are associated with more difficult retrievals. Several techniques for difficult retrievals have been described in the medical literature. These techniques range from modifications of standard retrieval techniques to much more complex interventions. Complications related to complex retrievals are more common than those associated with standard retrieval techniques. The risks of complex filter retrievals should be compared with those of life-long anticoagulation associated with an unretrieved filter, and should be individualized. This article summarizes current techniques for IVC filter retrieval from a clinical point of view, with an emphasis on advanced retrieval techniques.

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Section: Dissection Techniques Endobronchial Forceps Dissection and Rmentioning

confidence: 99%

Section: Dissection Techniques Endobronchial Forceps Dissection and Rmentioning

confidence: 99%

Section: Dissection Techniques Endobronchial Forceps Dissection and Rmentioning

confidence: 99%

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Inferior vena cava filter retrievals, standard and novel techniques

Kuyumcu¹,

Walker²

2016

Cardiovasc. Diagn. Ther.

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“…10) have been used to nibble at, or ''micro-dissect,'' the tissue surrounding the filter tip and potentially grasp and remove it [77][78][79]. This technique has been successfully used for both cone-shaped and trapezoidal filters [79]. This technique is naturally more invasive than simpler snare and displacement techniques because of the risk of vessel perforation or rupture [78].…”

Section: Rigid Bronchoscopy Forceps Thermal Etcmentioning

confidence: 99%

“…Minor complications have been reported with filter retrieval, including transient demonstration of caval wall injury [79]. Most of the literature focuses on the complications attributed to the filter's malpositioning rather than the retrieval per se, e.g.…”

Section: Complications Of Filter Retrievalmentioning

confidence: 99%

Advanced Techniques for Removal of Retrievable Inferior Vena Cava Filters

Iliescu

Haskal

2011

Cardiovasc Intervent Radiol

124

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Inferior vena cava (IVC) filters have proven valuable for the prevention of primary or recurrent pulmonary embolism in selected patients with or at high risk for venous thromboembolic disease. Their use has become commonplace, and the numbers implanted increase annually. During the last 3 years, in the United States, the percentage of annually placed optional filters, i.e., filters than can remain as permanent filters or potentially be retrieved, has consistently exceeded that of permanent filters. In parallel, the complications of long-or short-term filtration have become increasingly evident to physicians, regulatory agencies, and the public. Most filter removals are uneventful, with a high degree of success. When routine filter-retrieval techniques prove unsuccessful, progressively more advanced tools and skill sets must be used to enhance filter-retrieval success. These techniques should be used with caution to avoid damage to the filter or cava during IVC retrieval. This review describes the complex techniques for filter retrieval, including use of additional snares, guidewires, angioplasty balloons, and mechanical and thermal approaches as well as illustrates their specific application.

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Safety and Success Rates of Excimer Laser Sheath–Assisted Retrieval of Embedded Inferior Vena Cava Filters

et al. 2022

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ImportanceDespite historically high rates of use, most inferior vena cava (IVC) filters are not retrieved. The US Food and Drug Administration safety communications recommended retrieval when the IVC filter is no longer indicated out of concern for filter-related complications. However, failure rates are high when using standard techniques for retrieval of long-dwelling filters, and until recently, there have been no devices approved for retrieval of embedded IVC filters.ObjectiveTo evaluate the safety and success of excimer laser sheath–assisted retrieval of embedded IVC filters.Design, Setting, and ParticipantsA retrospective, multicenter, clinical cohort study of excimer laser sheath–assisted IVC filter retrievals from 7 US sites was conducted between March 1, 2012, and February 28, 2021, among 265 patients who underwent IVC filter retrieval using the laser. Patients were substratified between a high-volume single center and a multicenter data set. A blinded physician committee adjudicated reported complications and their association with use of the laser.ExposuresRetrieval of IVC filters using excimer laser sheath.Main Outcomes and MeasuresThe primary safety end point was device-related major complication rate (Society of Interventional Radiology categories C to F, which included any adverse event associated with morbidity or disability that increases the level of care, results in hospital admission, or substantially lengthens the hospital stay). The primary success end point was technical success of IVC filter retrieval. The primary end points were compared with literature-derived, meta-analysis–suggested target performance goals.ResultsThe single-center experience included 139 participants (mean [SD] age, 52 [16] years; 78 female participants [56.1%]), and the multicenter experience included 126 participants (mean [SD] age, 52 [16] years; 75 female participants [59.5%]). The device-related major complication rate was 2.9% (4 of 139; 95% CI, 0.8%-7.2%; P = .001) for the single-center experience and 4.0% (5 of 126; 95% CI, 1.3%-9.0%; P = .01) for the multicenter experience, both of which were significantly lower than the primary safety performance goal (10%). No major complications were considered to be definitively associated with use of the laser. The technical success rate was 95.7% (133 of 139; 95% CI, 90.8%-98.4%; P = .007) for the single-center experience and 95.2% (120 of 126; 95% CI, 89.9%-98.2%; P = .02) for the multicenter experience, both of which were significantly higher than the primary performance goal (89.4%).Conclusions and RelevanceThis cohort study demonstrated high technical success and low complication rates of excimer laser sheath–assisted retrieval of embedded IVC filters in centers with variable case volume and experience, which suggests a wide applicability of the technique with proper training. The excimer laser sheath offers physicians a valuable tool for retrieval of challenging embedded IVC filters.

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Embedded Inferior Vena Cava Filter Removal: Use of Endobronchial Forceps

Cited by 103 publications

References 22 publications

Inferior vena cava filter retrievals, standard and novel techniques

Inferior vena cava filter retrievals, standard and novel techniques

Advanced Techniques for Removal of Retrievable Inferior Vena Cava Filters

Safety and Success Rates of Excimer Laser Sheath–Assisted Retrieval of Embedded Inferior Vena Cava Filters

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