Factors Affecting Inferior Vena Cava Filter Retrieval: A Review

Abstract

Objective: Over the last 2 decades, there has been an exponential rise in placement of retrievable inferior vena cava (IVC) filters, while the retrieval rate has remained steadily low. Approaches to increasing filter retrieval rates have been extensively studied. Conclusion: This review presents an up-to-date review of reported data-driven variables that affect retrieval rates of IVC filters, with a focus on clinical, technical, and process factors.

Cardiac Tamponade Secondary to IVC Filter Retrieval

“…IVC filters are used in the setting of acute proximal venous thrombosis in patients who have either a contraindication to anticoagulation, experienced complications of anticoagulation, and/or as an adjunct in patients that have failed treatment with anticoagulation ( 1 , 2 ). IVC filters decrease the risk of PE but have no effect on overall survival ( 3 ).…”

“…Long-term complications of indwelling filters include thrombotic occlusion of the IVC and/or filter thrombosis, vascular wall penetration, filter fracture, filter migration, embolization, and penetration of surrounding visceral organs ( 1 , 3 , 4 , 5 ). Limited case reports have described filter fracture with embolization of fragments to and perforation of the right ventricle, leading to hemopericardium and cardiac tamponade ( 2 , 6 ).…”

“…Limited case reports have described filter fracture with embolization of fragments to and perforation of the right ventricle, leading to hemopericardium and cardiac tamponade ( 2 , 6 ). Given that device-related complications seem to increase with filter dwell time ( 4 ), the U.S. Food and Drug Administration has recommended that retrievable IVC filters be removed as soon as protection from PE is no longer needed ( 3 ).…”

Efficacy and safety of rivaroxaban in patients with inferior vena cava filter placement without anticoagulation contraindications (EPICT): a prospective randomised controlled trial study protocol

“…IVC filter retrieval failure is relevant to IVC filter complications (eg, IVC thrombosis, IVC perforation, IVC filter migration or tilting and IVC filter embolisation), system factors and technical factors. 31 We will also transform the retrieval IVC filters to permanent filters and prolong the duration of anticoagulant therapy. Bleeding will be defined as major if it is clinically overt and associated with a haemoglobin level decrease of 2.0 g/dL or more, if bleeding leads to the transfusion of two or more units of red cells or if bleeding is intracranial or retroperitoneal, occurs in another critical site or contributes to death.…”

Balloon-assisted inferior vena cava filter retrieval: A novel technique to enhance irretrievable filter extraction

“…In addition, factors such as epithelialization of filter parts, apex tilt, and prolonged dwelling time >6 months have been shown to further hinder extraction. [2] With these potential impediments, and as the necessity of filter removal becomes more evident, it is essential to have reliable techniques to enhance retrieval rates and minimize complications.…”