Inferior Vena Cava Filter Retrieval: Patient Selection, Procedural Planning, and Postprocedural Complications.

OBJECTIVE. Utilization of retrievable inferior vena cava filters (rIVCFs) has come under increased scrutiny because of historically high rates of placement, generalized lack of retrieval when the inferior vena cava filter (IVCF) is no longer indicated, and reports of device-related complications. These events have led to an increased interest in IVCF retrieval, including the development of advanced endovascular retrieval techniques and the proliferation of specialized clinical practices for rIVCFs. We aim to describe the indications for IVCF retrieval, patient selection, procedural planning, and procedural complications and management. CONCLUSION. IVCFs continue to have a role in the prevention of pulmonary embolism in select patients. Rising awareness of device-related complications paired with historically low retrieval rates has prompted renewed emphasis and interest in filter retrieval. Diligent follow-up and procedural planning permit prompt and safe filter retrieval.

A survey of vascular specialists' practice patterns of inferior vena cava filter placement and retrieval.

OBJECTIVES: The placement of inferior vena cava filters (IVCF) continues to rise. Vascular specialists adopt different practices based on local expertise. This study was performed to assess the attitudes of vascular specialists towards the placement and retrieval of IVCF. METHODS: An online survey of 28 questions related to practice patterns regarding IVCF was administered to 1429 vascular specialists. Vascular specialists were categorized as low volume if they place less than three IVCF per month and high volume if they place at least three IVCF per month. The responses of high volume and low volume were compared using two-sample t-tests and Chi-square tests. RESULTS: A total of 259 vascular specialists completed the survey (18% response rate). There were 191 vascular surgeons (74%) and 68 interventional radiologists (26%). The majority of responders were in academic practice (67%) and worked in tertiary care centers (73%). The retrievable IVCF of choice was Celect (27%) followed by Denali (20%). Forty-two percent used a temporary IVCF and left it in situ instead of using a permanent IVCF. Eighty-two percent preferred placing the tip of the IVCF at or just below the lowest renal vein. Thirty-one percent obtained a venous duplex of the lower extremities prior to retrieval while 24% did not do any imaging. There were 132 (51%) low volume vascular specialists and 127 (49%) high volume vascular specialists. Compared to low volume vascular specialists, significantly more high volume vascular specialists reported procedural times of less than 30 min for IVCF retrieval (57% vs. 42%, P = 0.026). There was a trend for high volume to have fewer unsuccessful attempts at IVCF retrieval but that did not reach statistical significance ( P = .061). High volume were more likely to have attempted multiple times to retrieve an IVCF (66% vs. 33%, P < .001), and to have used bronchoscopy forceps (32% vs. 14%, P = .001) or a laser sheath (14% vs. 2%, P < .001) for IVCF retrieval. In general, vascular specialists were not comfortable using bronchoscopy forceps (65%) or a laser sheath (82%) for IVCF retrieval. CONCLUSIONS: This study underscores significant variability in vascular specialists practice patterns regarding IVCF. More studies and societal guidelines are needed to define best practices.

IVC filter retrieval in adolescents: experience in a tertiary pediatric center.

BACKGROUND: Inferior vena cava (IVC) filters are commonly implanted with the intent to prevent life-threatening pulmonary embolism in at-risk patients with contraindications to anticoagulation. Various studies have reported increases in the rate of venous thromboembolism within the pediatric population. The utility and safety of IVC filters in children has not yet been fully defined. OBJECTIVE: To describe the technique and adjunctive maneuvers of IVC filter removal in children, demonstrate its technical success and identify complications. MATERIALS AND METHODS: A retrospective 10-year review was performed of 20 children (13 male, 7 female), mean age: 15.1 years (range: 12-19 years), who underwent IVC filter retrieval. Eleven of 20 (55%) were placed in our institution. Electronic medical records were reviewed for filter characteristics, retrieval technique, technical success and complications. RESULTS: The technical success rate was 100%. Placement indications included: deep venous thrombosis with a contraindication to anticoagulation (10/20, 50%), free-floating thrombus (4/20, 20%), post-trauma pulmonary embolism prophylaxis (3/20, 15%) and pre-thrombolysis pulmonary patient (1/20, 5%). The mean implantation period was 63 days (range: 20-270 days). Standard retrieval was performed in 17/20 patients (85%). Adjunctive techniques were performed in 3/20 patients (15%) and included the double-snare technique, balloon assistance and endobronchial forceps retrieval. Median procedure time was 60 min (range: 45-240 min). Pre-retrieval cavogram demonstrated filter tilt in 5/20 patients (25%) with a mean angle of 17° (range: 8-40). Pre-retrieval CT demonstrated strut wall penetration and tip embedment in one patient each. There were two procedure-related complications: IVC mural dissection noted on venography in one patient and snare catheter fracture requiring retrieval in one patient. There were no early or late complications. CONCLUSION: In children, IVC filter retrieval can be performed safely but may be challenging, especially in cases of filter tilt or embedding. Adjunctive techniques may increase filter retrieval rates.

Complications Associated With Inferior Vena Cava Filter Retrieval: A Systematic Review.

Inferior vena cava (IVC) filters have been used successfully in high-risk patients to prevent thromboembolism. The filters are widely created as retrievable devices, but complication rates progressively increase during IVC filter retrieval. This study aims to analyze IVC filter retrieval cases and associated complications during and following the procedures regarding dwell times, specific filter types, filter positioning, and advanced retrieval techniques. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to select and analyze relevant articles. A literature search for articles was performed on September 23, 2023, through three research databases: PubMed, ProQuest, and ScienceDirect. The keywords used to identify relevant publications were "IVC Filter retrieval AND complications" and "IVC filter removal AND complications". The articles before 2012 were excluded. Relevant articles were selected based on the inclusion and exclusion criteria. In total, 20,435 articles were found: 812 from PubMed, 15,635 from ProQuest, and 3,988 from Science Direct. Among the exclusions were 18,462 articles, which were excluded in the automatic screening process, leaving 1,973 for manual screening. The manual screening of articles was conducted based on title, abstract, article type, duplicates, and case reports, where 1,918 articles were excluded. Ultimately, 55 articles were included in this review. This study demonstrates that IVC filter retrievals have significant complication rates. Many complications have a common theme: prolonged dwell time and lost follow-up appointments. Therefore, importance should be placed on patient education and implementing strict protocols regarding the timelines of IVC filter removals.

Predictors of endobronchial forceps utilization for inferior vena cava filter retrieval: when snare retrieval fails.

BACKGROUND: Endobronchial forceps are commonly used for complex IVC filter removal and after initial attempts at IVC filter retrieval with a snare have failed. Currently, there are no clear guidelines to help distinguish cases where primary removal should be attempted with standard snare technique or whether attempts at removal should directly be started with forceps. This study is aimed to identify clinical and imaging predictors of snare failure which necessitate conversion to endobronchial forceps. METHODS: Retrospective analysis of 543 patients who underwent IVC filter retrievals were performed at three large quaternary care centers from Jan 2015 to Jan 2022. Patient demographics and IVC filter characteristics on cross-sectional images (degree of tilt, hook embedment, and strut penetration, etc.) were reviewed. Binary multivariate logistic regression was used to identify predictors of IVC filter retrieval where snare retrieval would fail. RESULTS: Thirty seven percent of the patients (n = 203) necessitated utilization of endobronchial forceps. IVC filter hook embedment (OR:4.55; 95%CI: 1.74-11.87; p = 0.002) and strut penetration (OR: 56.46; 95% CI 20.2-157.7; p = 0.001) were predictors of snare failure. In contrast, total dwell time, BMI, and degree of filter tilt were not associated with snare failure. Intraprocedural conversion from snare to endobronchial forceps was significantly associated with increased contrast volume, radiation dose, and total procedure times (p < 0.05). CONCLUSION: IVC filter hook embedment and strut penetration were predictors of snare retrieval failure. Intraprocedural conversion from snare to endobronchial forceps increased contrast volume, radiation dose, and total procedure time. When either hook embedment or strut penetration is present on pre-procedural cross-sectional images, IVC filter retrieval should be initiated using endobronchial forceps. LEVEL OF EVIDENCE: Level 3, large multicenter retrospective cohort.

Management of failed inferior vena cava filter retrieval for complex cases: A case series.

The aim of this report is to describe our experience in managing cases of difficult inferior vena cava (IVC) filter retrieval with emphasis on different advanced retrieval techniques. We report three cases of difficult IVC filter retrieval at our institution. We included three patients age ranging from 42 to 72 years. Two of the cases were presenting with the lower limb deep vein thrombosis and one of the cases had pulmonary embolism and they all had Retrievable Celect Platinum IVC filter (Cook Medical, Bloomington, Ind.) inserted preoperatively. One case was managed conservatively after failing IVC filter retrieval using standard retrieval set, meaning the filter was left in place, one was successfully removed with advanced endovascular retrieval techniques, and one failing advanced endovascular retrieval and finally had it removed with open surgery. We reviewed the risk factors contributing to difficult IVC filter retrieval and discussed the different options for managing these cases including conservative management, endovascular treatment, and open surgery for retrievable type of IVC filter which can be placed permanently. Knowledge of these options will help us better understand conditions, leading to difficult IVC retrieval on insertion, hopefully to minimize the occurrence of these cases, and to better manage cases with difficult IVC filter retrieval to decide the best option for each patient after careful consideration and multidisciplinary discussion with surgeons and patients.

An Internal Hernia With Small Bowel Volvulus From an Inferior Vena Cava Filter Wire Strut: A Rare Cause of Acute Abdomen.

The use of inferior vena cava (IVC) filters has been increasingly prevalent. Although they are relatively safe with clear indications, they are not without complications. Late-onset complications include IVC filter migration, IVC wire fracture, wire strut penetration, and perforation of organs in its vicinity. In this report, we present the case of a patient with small bowel volvulus secondary to an IVC wire strut migration, causing tethering of the mesentery and vascular compromise to the small bowel.

Bidirectional Sling Technique with Biopsy Forceps for Inferior Vena Cava Filter Retrieval.

Although the importance of the retrieval of an optional inferior vena cava filter (o-IVCF) has gained attention because of the awareness of a high complication rate with long indwelling time, the o-IVCF retrieval rate remains low. The advanced retrieval technique of o-IVCF may increase the retrieval rate, which in turn diminishes future adverse events. Through two cases, we describe how to perform the novel approach "bidirectional sling technique with biopsy forceps." This technique will improve the retrieval rate in patients following the failure by conventional retrieval technique.

Costs and complications of hospital admissions for inferior vena cava filter malfunction.

OBJECTIVE: Inferior vena cava filter (IVCF) malfunction can result from penetration, fracture, or migration of the device necessitating retrieval. Endovascular and open retrieval of IVCF have been described in institutional series without comparison. This study examines national hospital admissions for IVCF malfunction and compares the outcomes of open and endovascular retrieval. METHODS: The National Inpatient Sample database (2016-2017) was reviewed for admissions with International Classification of Diseases, Tenth Revision (ICD-10) codes specific for IVCF malfunction. All ICD-10 procedural codes were reviewed, and patients were divided based on open or endovascular IVCF retrieval. Patient characteristics, outcomes, and costs of hospitalization were compared between the two groups. RESULTS: There were 665 patients admitted with a diagnosis of IVCF malfunction. Open IVCF retrieval was performed in 100 patients and endovascular removal in 90 patients. Of those undergoing open surgery, 45 patients (45%) required median sternotomy and 55 (55%) required abdominal surgeries. Most patients were white females with a mean age of 54.4 years (range, 49.3-59.6 years) with a history of deep venous thrombosis (55.3%) or pulmonary embolism (31.6%). Most patients with IVCF malfunction were treated in large (81.6%) or urban teaching (94.7%) hospitals situated most commonly in the South (42.1%) and Northeast (29.0%) with no difference in characteristics of the patients or the centers between the two groups. Patients undergoing open IVCF retrieval were more likely to undergo surgery on an elective basis compared with endovascular IVCF retrieval (75.0% vs 11.1%; P < .001). Open IVCF retrieval was associated with a higher likelihood of thromboembolic complication compared with endovascular retrieval (20% vs 0%; P = .04). There was a trend toward higher infectious complications and overall complications with endovascular removal, but this difference did not reach statistical significance. Open retrieval was associated with a mortality of 5.0% compared with no inpatient mortality with endovascular retrieval (P = .33). The mean hospital length of stay was no difference between the two groups. Open retrieval was associated with significantly higher hospital costs than endovascular retrieval ($34,276 vs $19,758; P = .05). CONCLUSIONS: Filter removal for patients with IVCF malfunction is associated with significant morbidity and cost, regardless of modality of retrieval. The introduction of specific ICD-10 codes for IVCF malfunction allows researchers to study these events. The development of effective tools for outpatient retrieval of malfunctioning IVCF could decrease related hospitalization and have potential savings for the healthcare system.

Endovascular Rescue of Sheath Perforation During Inferior Vena Cava Filter Retrieval.

INTRODUCTION: Inferior vena cava (IVC) filter retrieval is generally a straightforward procedure but can be challenging with unique complications. A technique used for endovascular rescue of a patient where sheath perforation by the IVC filter occurred during IVC filter retrieval is described. REPORT: A 75 year old man underwent retrieval of an IVC filter that had been in place for 10 months. Using the IVC filter retrieval set from a standard right internal jugular vein approach and the loop-snare technique, the hook and collet were captured, and the filter was collapsed into the retrieval sheath. Approximately halfway through removal of the filter through the sheath, mild resistance was encountered and the tip of the IVC filter was found to have perforated the side of the retrieval sheath. The sheath appeared to have bent slightly in this region, probably weakening the sheath wall and creating angulation, which allowed sheath perforation to occur. From a right common femoral vein approach, an Amplatz wire was used to cannulate the distal end of the perforated sheath. A balloon was then used to pull the perforated sheath with the IVC filter into a larger sheath. After removing the Tuohy-Borst and Luer adapters on the perforated sheath, it was able to be internalised and removed via the femoral vein sheath. DISCUSSION: The endovascular rescue technique described herein may prove useful to other practitioners encountering similar situations, and the complication shows areas of caution when using the loop-snare retrieval technique.

Factors Affecting Inferior Vena Cava Filter Retrieval: A Review.

OBJECTIVE:: Over the last 2 decades, there has been an exponential rise in placement of retrievable inferior vena cava (IVC) filters, while the retrieval rate has remained steadily low. Approaches to increasing filter retrieval rates have been extensively studied. CONCLUSION:: This review presents an up-to-date review of reported data-driven variables that affect retrieval rates of IVC filters, with a focus on clinical, technical, and process factors.

Costs and complications of endovascular inferior vena cava filter retrieval.

OBJECTIVE: Advanced endovascular techniques are frequently used for challenging inferior vena cava (IVC) filter retrieval. However, the costs of IVC filter retrieval have not been studied. This study compares IVC filter retrieval techniques and estimates procedural costs. METHODS: Consecutive IVC filter retrievals performed at a tertiary center between 2009 and 2014 were retrospectively reviewed. Procedures were classified as standard retrieval (SR) if they required only a vascular sheath and a snare device and as advanced endovascular retrieval (AER) if additional endovascular techniques were used for retrieval. Cost data were based on hospital bills for the procedures. Patients' characteristics, filter dwell time, retrieval procedure details, complications, and costs were compared between the groups. All statistical comparisons were performed using SAS 9.3 software. RESULTS: There were 191 IVC filter retrievals (SR, 157; AER, 34) in 183 patients (mean age, 55 years; 51% male). Fifteen filters (7.9%) were placed at an outside hospital. The indications for placement were mostly therapeutic (76% vs 24% for prophylaxis). All IVC filters were retrievable, with Bard Eclipse (Bard Peripheral Vascular, Tempe, Ariz; 34%) and Cook Günther Tulip (Cook Medical, Bloomington, Ind; 24%) the most common. Venous ultrasound examination of the lower extremities of 133 patients (70%) was performed before retrieval, whereas only 5 patients (2.6%) received a computed tomography scan of the abdomen. There was no difference in the mean filter dwell time in the two groups (SR, 147.9 ± 146.1 days; AER, 161.4 ± 91.3 days; P = .49). AERs were more likely to have had prior attempts at retrieval (23.5%) compared with SRs (1.9%; P < .001). The most common AER techniques used were the wire loop and snare sling (47.1%) and the stiff wire displacement (44.1%). Bronchoscopy forceps was used in four cases (11.8%); this was the only off-label device used. AERs were more likely to require more than one venous access site for the retrieval procedure (23.5% vs 0%; P < .001). AERs were significantly more likely to have longer fluoroscopy time (34.4 ± 18.3 vs 8.1 ± 7.9 minutes; P < .001) and longer total procedural time (102.8 ± 59.9 vs 41.1 ± 25.0 minutes; P < .001) compared with SRs. The complication rate was higher with AER (20.6%) than with SR (5.2%; P = .006). Most complications were abnormal radiologic findings that did not require additional intervention. The procedural cost of AER was significantly higher (AER, $14,565 ± $6354; SR, $7644 ± $2810; P < .001) than that of SR. This translated to an average increase in cost of $6921 ± $3544 per retrieval procedure for AER. CONCLUSIONS: Advanced endovascular techniques provide a feasible alternative when standard IVC filter retrieval techniques do not succeed. However, these procedures come with a higher cost and higher rate of complications.

Endovascular Retrieval of a Migrated TrapEase Inferior Vena Cava Filter From the Right Atrium: A Brief Report and Literature Review.

Intracardiac migration is a rare complication of inferior vena cava filters (IVCFs) that poses a significant risk to patients. Both endovascular and surgical options exist, although only a few endovascular options are described in the literature. This brief report describes the endovascular approach used to successfully remove a TrapEase IVCF from the right atrium in a single patient. A brief review of the literature is also provided.

Observations on failed retrieval of optional inferior vena cava filters.

PURPOSE: To evaluate causes of failed optional inferior vena cava filter (IVCF) retrievals. METHODS: Single-center retrospective study. RESULTS: IVCF retrievals were attempted in 26/211 (12%) patients at a mean 42.9 days. There were 9 failures (all OptEase) due to: inability to snare the hook (n=5), noncollapsible IVCF (n=3), and unusual procedural pain (n=1). Median duration of retrieved IVCFs was 31 days compared to 53 days for failures (P<.05). IVCFs aligned with the IVC's cephalocaudal axis were retrieved in 13/16 cases, while misaligned IVCFs were retrieved 4/10 cases (P<.05). CONCLUSION: Filter duration and misalignment were significantly associated with retrieval failures.

Total laparoscopic retrieval of inferior vena cava filter.

While there is some local variability in the use of inferior vena cava filters and there has been some evolution in the indications for filter placement over time, inferior vena cava filters remain a standard option for pulmonary embolism prophylaxis. Indications are clear in certain subpopulations of patients, particularly those with deep venous thrombosis and absolute contraindications to anticoagulation. There are, however, a variety of reported inferior vena cava filter complications in the short and long term, making retrieval of the filter desirable in most cases. Here, we present the case of a morbidly obese patient complaining of chronic abdominal pain after inferior vena cava filter placement and malposition of the filter with extensive protrusion outside the inferior vena cava. She underwent successful laparoscopic retrieval of her malpositioned inferior vena cava filters after failure of a conventional endovascular approach.