Techniques Used for Difficult Retrievals of the Günther Tulip Inferior Vena Cava Filter: Experience in 32 Patients

Ha, Thuong G. Van; Vinokur, Olga; Lorenz, Jonathan M.; Regalado, Sidney; Zangan, Steven; Piano, Giancarlo; Funaki, Brian

doi:10.1016/j.jvir.2008.10.007

Cited by 58 publications

(25 citation statements)

References 27 publications

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“…An angioplasty balloon is then advanced over the guidewire between the embedded filter and the caval wall and is inflated in order to realign the filter more centrally within the IVC. This may then provide a better angle for snaring the filter hook (17,18). Another advantage of this technique is that even partial tracts that are created by the guidewire may be used to sequentially separate the embedded areas of the IV filter from the caval wall in a piecemeal fashion.…”

Section: Balloon-displacement Techniquementioning

confidence: 99%

“…Stavropoulos et al later concluded that this endobronchial forceps technique could be safely used to successfully remove embedded filters (21,22). In this technique a rigid endobronchial forceps is introduced through a large caliber venous access sheath (14)(15)(16)(17)(18) and is used to dissect the hook of the IVC filter free from the caval wall. The tip or hook of the filter may then be grasped with the forceps so that the access sheath can be advanced over the filter apex in order to collapse the filter and allow subsequent removal using the forceps (Figure 8).…”

Section: Dissection Techniques Endobronchial Forceps Dissection and Rmentioning

confidence: 99%

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Inferior vena cava filter retrievals, standard and novel techniques

Kuyumcu¹,

Walker²

2016

Cardiovasc. Diagn. Ther.

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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.

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Section: Balloon-displacement Techniquementioning

confidence: 99%

Section: Dissection Techniques Endobronchial Forceps Dissection and Rmentioning

confidence: 99%

Inferior vena cava filter retrievals, standard and novel techniques

Kuyumcu¹,

Walker²

2016

Cardiovasc. Diagn. Ther.

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“…A variety of factors are known be associated with higher routine retrieval failure rates including longer dwell time, more transverse tilt, and presence of an embedded hook (1)(2)(3)(4). It has been postulated that fibrin caps form around the IVC filter apex when their position is near the caval wall (5,6).…”

Section: Discussionmentioning

confidence: 99%

“…When conventional methods of retrieval fail, the operator must use creative means to extract the filter. Failure of retrieval is associated with a longer dwell time, more transverse tilt, and the presence of an embedded hook (1)(2)(3)(4). A variety of advanced techniques have been reported in the literature when conventional methods fail.…”

mentioning

confidence: 99%

Günther Tulip inferior vena cava filter retrieval using a bidirectional loop-snare technique

Ross

Allison²,

Vaidya³

et al. 2016

Diagn Interv Radiol

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Inferior vena cava (IVC) filters are an effective means to prevent pulmonary embolism in the setting of a contraindication to anticoagulation. Their ease of placement and retrieval makes them a frequently used tool in interventional radiology. When conventional methods of retrieval fail, the operator must use creative means to extract the filter. Failure of retrieval is associated with a longer dwell time, more transverse tilt, and the presence of an embedded hook (1-4). A variety of advanced techniques have been reported in the literature when conventional methods fail. A rare cause of conventional failure is straightening of the filter hook when excessive axial force is applied. In this case report we encountered this complication along with adhered filter leg anchors likely secondary to fibrin scar formation. This report describes a novel technique for IVC filter retrieval through the use of a bidirectional loop-snare. TechniqueThis case report was approved by our institutional review board. A 52-year-old woman with a history of ulcerative colitis and end-stage liver disease secondary to primary sclerosing cholangitis presented to our institution with decompensated liver disease after a failed hepatic transplant. A computed tomography (CT) scan demonstrated thrombosis of the right ovarian vein with extension into the infrarenal IVC. Interventional radiology was consulted for IVC filter placement due to ongoing surgical needs. A Günther Tulip filter (Cook Medical) was placed using conventional methods. A subsequent abdominal CT demonstrated adequate placement of the IVC filter in the suprarenal IVC, with the apex centered in the vein (Fig. 1).The patient presented for filter removal 224 days after installation. A preprocedural CT was not performed. However, it was noted that the patient had a diagnostic CT of the abdomen and pelvis for unrelated reasons four months prior to retrieval, which demonstrated an unchanged position without invasion. Internal jugular venous access was obtained using conventional techniques and inferior vena cavography confirmed adequate placement of the filter. While the filter apex appeared to be centered within the IVC, pre-retrieval vena cavography demonstrated several of the filter legs to extend beyond the contrast, indicating wall implantation versus fibrin scar formation around the anchors (Fig. 2). A Günther Tulip filter retrieval kit (Cook Medical) was used to engage the filter hook. The sheath was advanced under significant force over the filter but the leg anchors would not dislodge from the IVC wall (Fig. 3). No buckling was observed while advancing the sheath over the filter, therefore a stiffer sheath was not thought to be of benefit. The IVC collapsed intermittently with each advancement of the sheath. During the initial attempt at removal the snare straightened the filter hook, so that it could no longer be engaged through standard means. As an alternative, a reverse curve SOS catheter (AngioDynamics) was used to direct a ABSTRACTMany advanced techniques have been rep...

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“…6). The balloon is then inflated between the apex of the filter or its embedded struts, thus displacing it from the caval wall [73]. The balloon displacement technique can be used with or without a through-and-through guidewire.…”

Section: Balloon-displacement Techniquementioning

confidence: 99%

Advanced Techniques for Removal of Retrievable Inferior Vena Cava Filters

Iliescu

Haskal

2011

Cardiovasc Intervent Radiol

124

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Inferior vena cava (IVC) filters have proven valuable for the prevention of primary or recurrent pulmonary embolism in selected patients with or at high risk for venous thromboembolic disease. Their use has become commonplace, and the numbers implanted increase annually. During the last 3 years, in the United States, the percentage of annually placed optional filters, i.e., filters than can remain as permanent filters or potentially be retrieved, has consistently exceeded that of permanent filters. In parallel, the complications of long-or short-term filtration have become increasingly evident to physicians, regulatory agencies, and the public. Most filter removals are uneventful, with a high degree of success. When routine filter-retrieval techniques prove unsuccessful, progressively more advanced tools and skill sets must be used to enhance filter-retrieval success. These techniques should be used with caution to avoid damage to the filter or cava during IVC retrieval. This review describes the complex techniques for filter retrieval, including use of additional snares, guidewires, angioplasty balloons, and mechanical and thermal approaches as well as illustrates their specific application.

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Techniques Used for Difficult Retrievals of the Günther Tulip Inferior Vena Cava Filter: Experience in 32 Patients

Cited by 58 publications

References 27 publications

Inferior vena cava filter retrievals, standard and novel techniques

Inferior vena cava filter retrievals, standard and novel techniques

Günther Tulip inferior vena cava filter retrieval using a bidirectional loop-snare technique

Advanced Techniques for Removal of Retrievable Inferior Vena Cava Filters

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