Safety and Efficacy of Inferior Vena Cava Filter Retrieval: A 5-year Single Center Retrospective Review from A Tertiary Care Center

Abstract

Background: Inferior vena cava (IVC) filter retrieval is typically accomplished with a standard loop snare. When this fails, more advanced techniques are necessary, especially when removal falls outside a 12-month window. Complications during filter retrieval depend heavily on technique, type of filter, and filter position. In this study we examined safety and efficacy of 536 filter retrievals at a tertiary care center and compared complication rates between standard loop snare and endobronchial forcep retrieval. Method: We reviewed 536 cases between August 2015 and August 2020, recording retrieval success rates, patient comorbidities, and complication rates at the time of removal. Results: Total overall retrieval success was 97.9% (525/536), and complications occurred in approximately 6.0% (32/536) of all cases. Success and complications with standard snare technique alone were 99.4% (345/347) and 1.7% (5 Grade I/II, 1 Grade III) and advanced forcep technique 98.8% (171/173) and 14.5% (22 Grade I/II, 2 Grade III, and 1 Grade IV), respectively. There was no significant difference between the technical success rates of the isolated loop snare and forceps techniques (p=0.60) despite a significantly longer dwell time in patients undergoing forceps retrieval ( p<0.001). Conclusion: To our knowledge, this is the largest cohort of forceps directed IVC filter retrieval present in the literature. Successful endobronchial forceps and loop-snare retrieval rates in this study are similar to previous reports. Although use of endobronchial forceps may be associated with higher complication rates, this is likely due to prolonged dwell times, filter tilt, and attempted removal of non retrievable filters. Overall, forceps-directed retrieval offers a safe, effective means of removal in difficult cases. Level of Evidence: Level 3, Large Retrospective Study