Inferior Vena Cava Filter Retrieval: Effectiveness and Complications of Routine and Advanced Techniques

Al-Hakim, Ramsey; Kee, Stephen T.; Olinger, Kristen; Lee, Edward W.; Moriarty, John M.; McWilliams, J.

doi:10.1016/j.jvir.2014.01.019

Cited by 138 publications

(97 citation statements)

References 19 publications

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“…Al-Hakim et al 14 reported a complication rate of 5.3% when using advanced retrieval techniques. In the present study, our overall complication rate was 2%; in a previous analysis, we found no association between adverse event rates and filter dwell time or use of advanced techniques on multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

“…12 The development of advanced retrieval techniques has had a significant impact on rIVCF retrieval rates, particularly for devices that are in place for extended periods of time or are embedded. [13][14][15] However, there is currently no specific definition of what rIVCF dwell time requires increased use of advanced retrieval techniques. We aim to define prolonged rIVCF dwell time by evaluating the time point when the risk of standard retrieval technique failure increases significantly, necessitating advanced retrieval techniques to maintain overall technical success of retrieval.…”

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confidence: 99%

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Defining Prolonged Dwell Time: When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary?

Desai

Laws

Salem

et al. 2017

Circ: Cardiovascular Interventions

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Background— Despite growth in placement of retrievable inferior vena cava filters, retrieval rates remain low. Filters with extended implantation times present a challenge to retrieval, where standard techniques often fail. The development of advanced retrieval techniques has positively impacted retrieval of retrievable inferior vena cava filters with prolonged dwell times; however, there is no precise definition of the time point when advanced techniques become necessary. We aim to define prolonged retrievable inferior vena cava filters dwell time by determining the inflection point when the risk of standard retrieval technique failure increases significantly, necessitating advanced retrieval techniques to maintain overall technical success of retrieval. Methods and Results— From January 2009 to April 2015, 762 retrieval procedures were identified from a prospectively acquired database. We assessed patient age/sex, filter dwell time, procedural technical success, the use of advanced techniques, and procedure-related adverse events. Overall retrieval success rate was 98% (n=745). When standard retrieval techniques failed, advanced techniques were used; this was necessary 18% of the time (n=138). Logistic regression identified that dwell time was the only risk factor for failure of standard retrieval technique (odds ratio, 1.08; 95% confidence interval, 1.05–1.10; P <0.001). Spline function regression analysis demonstrated that if dwell time exceeded 7 months, the risk of standard technique failure was 40.9%. Adverse events occurred at a rate of 2% (n=18; 15 minor and 3 major). Conclusions— The necessity of advanced techniques to maintain technical success of retrieval increases with dwell time. Patients with retrievable inferior vena cava filters in place beyond 7 months may benefit from referral to centers with expertise in advanced filter retrieval.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Defining Prolonged Dwell Time: When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary?

Desai

Laws

Salem

et al. 2017

Circ: Cardiovascular Interventions

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“…Improved success with advanced technique is also associated with significantly higher complication rate. Al-Hakim et al [3] reported a complication rate of 5.3% when advanced retrieval techniques were needed compared to 0.4% ( P < .05) for standard technique. Lind et al [10] recently reported a successful case of Günther-Tulip filter retrieval after dwell time of 3334 days.…”

Section: Discussionmentioning

confidence: 99%

“…Use of adjunctive or advanced techniques improve retrieval rate. Al-Hakim et al and Kuo et al [3], [6] reported success rates of 94.7 and 100% with the use of advanced technique for complex filter retrieval. Improved success with advanced technique is also associated with significantly higher complication rate.…”

Section: Discussionmentioning

confidence: 99%

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Late endovascular removal of Günther-Tulip inferior vena cava filter and stent reconstruction of chronic post-thrombotic iliocaval obstruction after 4753 days of filter dwell time: a case report with review of literature

Doshi

Narayanan

2016

Radiology Case Reports

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Chronic post-thrombotic obstruction of the inferior vena cava (IVC) or iliocaval junction is an uncommon complication of long indwelling IVC filter. When such an obstruction is symptomatic, endovascular treatment options include stent placement with or without filter retrieval. Filter retrieval becomes increasingly difficult with longer dwell times. We present a case of symptomatic post-thrombotic obstruction of the iliocaval junction related to Günther-Tulip IVC filter (Cook Medical Inc, Bloomington, IN) with dwell time of 4753 days, treated successfully with endovascular filter removal and stent reconstruction. Filter retrieval and stent reconstruction may be a treatment option in symptomatic patients with filter-related chronic IVC or iliocaval junction obstruction, even after prolonged dwell time.

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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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Inferior Vena Cava Filter Retrieval: Effectiveness and Complications of Routine and Advanced Techniques

Cited by 138 publications

References 19 publications

Defining Prolonged Dwell Time: When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary?

Defining Prolonged Dwell Time: When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary?

Late endovascular removal of Günther-Tulip inferior vena cava filter and stent reconstruction of chronic post-thrombotic iliocaval obstruction after 4753 days of filter dwell time: a case report with review of literature

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

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