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

Abstract

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.

Laser-assisted permanent greenfield filter removal with ileocaval stent reconstruction following filter thrombosis, a case report

“…Advanced techniques are used when traditional techniques have failed and they include removal using endobronchial forceps, balloon displacement techniques, realignment of the filter with an angle-guided catheter, the “sling” technique using a curved wire, and stiff wire displacement [ 20 , 3 ] Recently, laser sheath assisted photoablation has also been described for removal of filters. Success rates of laser sheath-assisted retrieval of embedded IVC filters range from 95% to 100% with a 4% risk of major device-related complications, which suggests the effectiveness and safety of this retrieval method [ 21 , 22 ]. Additionally, preprocedural catheter-directed administration of tissue plasminogen activator (tPA) and recanalization of the IVC may also facilitate successful retrievals [3] .…”

Inferior Vena Cava Filters: A Clinical Review and Future Perspectives

“…Lastly, new procedures have been proposed for caval filter retrieval, in particular in the context of long-dwelling IVC filters, which are notoriously difficult to remove with standard techniques and are at risk of complications (e.g., fracture, migration or thrombosis) [ 83 , 84 ]. For instance, a recent study [ 85 ] evaluated the use of the excimer laser sheath for retrieval of embedded IVC filters, a device commonly used for the extraction of pacemaker and defibrillator leads. This procedure was associated with a high success rate (95.2%, 95% CI, 89.9–98.2%, p = 0.02) and a low rate (4%, 95% CI, 1.3–9.0, p = 0.01) of major complications, defined as any adverse event associated with morbidity or disability or resulting in hospital admission.…”