Inferior vena cava filter retrievals, standard and novel techniques

Abstract

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.

Procedural complications of inferior vena cava filter retrieval, an illustrated review

“…4). Undesired re-orientation is also known to occur with the sling technique, especially with malleable nitinol filters (Kuyumcu and Walker 2016). A modification of this technique can be used to realign the filter into an upright position which is then followed by loop snaring of the hook.…”

Inferior Vena Cava Filter-Induced Thrombosis: Filter Insertion Prior to Catheter-Directed Thrombolysis and Successful Double-Filter Retrieval after Prolonged Indwelling Time

“… 6 ) Reasons for filter retrieval failure include lack of patient follow-up, large thrombus within the filter, significant filter tilt, embedded filter tip, embedded filter struts, strut perforation, and filter fracture. 7 ) Physician oversight is another reason for retrieval failure. 6 )…”

The Clinical Rationale for the Sentry Bioconvertible Inferior Vena Cava Filter for the Prevention of Pulmonary Embolism

“…Recent reviews have analyzed standard and advanced techniques for achieving IVC filter retrieval, including such methods as laser thermal and endobronchial forceps dissection [50, 53, 54]. Case reports have described open surgical removal of IVC filters, a last resort for patients with symptoms referable to filter strut penetration, such as chronic back and abdominal pain, after failed endovascular attempts [55].…”