Background— Despite growth in placement of retrievable inferior vena cava filters, retrieval rates remain low. Filters with extended implantation times present a challenge to retrieval, where standard techniques often fail. The development of advanced retrieval techniques has positively impacted retrieval of retrievable inferior vena cava filters with prolonged dwell times; however, there is no precise definition of the time point when advanced techniques become necessary. We aim to define prolonged retrievable inferior vena cava filters dwell time by determining the inflection point when the risk of standard retrieval technique failure increases significantly, necessitating advanced retrieval techniques to maintain overall technical success of retrieval. Methods and Results— From January 2009 to April 2015, 762 retrieval procedures were identified from a prospectively acquired database. We assessed patient age/sex, filter dwell time, procedural technical success, the use of advanced techniques, and procedure-related adverse events. Overall retrieval success rate was 98% (n=745). When standard retrieval techniques failed, advanced techniques were used; this was necessary 18% of the time (n=138). Logistic regression identified that dwell time was the only risk factor for failure of standard retrieval technique (odds ratio, 1.08; 95% confidence interval, 1.05–1.10; P <0.001). Spline function regression analysis demonstrated that if dwell time exceeded 7 months, the risk of standard technique failure was 40.9%. Adverse events occurred at a rate of 2% (n=18; 15 minor and 3 major). Conclusions— The necessity of advanced techniques to maintain technical success of retrieval increases with dwell time. Patients with retrievable inferior vena cava filters in place beyond 7 months may benefit from referral to centers with expertise in advanced filter retrieval.

dian proportion of associated news stories that reported the causality limitation was only 9% (range, 0%-100%). Among 31 news stories that reported a causality limitation, 16 (52%) included a disclaimer. Study authors were responsible for 18 (58%) of these limitation statements but also for 14 (88%) of the disclaimers.

Placement of retrievable inferior vena cava filters has seen rapid growth since their introduction into clinical practice. When retrieved, these devices offer the notional benefit of temporary protection from pulmonary embolism related to lower extremity deep venous thrombosis, and mitigation of filter-related deep venous thrombosis. When promptly removed after the indication for mechanical prophylaxis is no longer present, standard endovascular retrieval techniques are frequently successful. However, the majority of these devices are left in place for extended periods of time, which has been associated with greater device-related complications when left in situ, and failure of standard techniques when retrieval is attempted. The development of advanced retrieval techniques has had a positive impact on retrieval of these embedded devices. In this article, technical considerations in the retrieval of such devices, with an emphasis on advanced techniques to facilitate retrieval of embedded devices, are discussed.

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Patients who underwent both filter placement and retrieval at our institution were included. Chart review was used to obtain relevant data including indication for filter placement, length of the removal procedure, retrieval success, and the use of advanced retrieval techniques. Results: 196 filter placement / retrieval pairs were identified involving 192 patients (93 men, 99 women, mean age 57 Ϯ 14.6 years). Filter types were Denali (107), Option (43), Gunther Tulip (39), Celect (6), and Greenfield (1). The most common indications for filter placement included pre-operative or post-operative thromboembolic disease (61%), history of hemorrhage on anticoagulation or other risk factors for bleeding (21%), and massive pulmonary embolism (5%). Average length of the retrieval procedure was 34.3 minutes with Option retrievals requiring significantly more time (48.8 min; po0.01) when compared to the rest (Tulip 34.8 min, Denali 28.8 min, and Celect 25.5 min). IVC filter retrieval was unsuccessful in 8 of the 196 cases (4%) including 5 Option, 2 Tulip, and 1 Denali filters. Retrieval failure was significantly higher for the Option filters (11.6%; po0.01). Advanced retrieval techniques (triple snare, snare over loop guidewire, or forceps) were required for 19 of the retrievals (9.6%). The use of advanced techniques was significantly higher with the Option filters (32.6%; po0.01). Complications arose during 4 of the retrieval procedures, including access site hematoma, induced arrhythmia, hemopericardium, and extravasation from the inferior vena cava. Conclusions: IVC filters can be safely removed in the majority of patients particularly when the operators are familiar with advanced retrieval techniques. Of the types included in the study, the Denali and Gunther Tulip filters had comparable retrieval statistics while Option filters were more difficult to remove based on multiple metrics.