Case report: Endoluminal removal of a retrievable conical inferior vena cava filter with a ruptured retraction hook attached to the wall

Abstract

We report the case of a patient who underwent endovascular retrieval of a conical inferior vena cava (IVC) filter with a ruptured retraction hook that was attached to the IVC wall. A 21-year-old woman with a Celect (Cook) filter, implanted 1,522 days prior, requested retrieval. Preoperative ultrasound and CT examinations showed that the filter was inclined, the retraction hook was attached to the IVC wall, and one of the filter’s pedicles was broken. The inferior vena cava was patent, with no thrombus. Old superficial femoral vein thrombosis could be seen in the right lower extremity. The filter retrieval equipment (Gunther Tulip, Cook) failed to capture the retraction hook. By means of a pigtail catheter (with a partly removed catheter tip) and loach guidewire, we applied a modified loop-snare technique to successfully cut the proliferative tissue near the tip of the retraction hook, by which the hook re-entered the inferior vena cava. Although the snare successfully captured the retraction hook and retrieved the filter, the broken pedicle was retained in the inferior vena cava. We used forceps to capture and pull it to the distal end. In the end, the inferior vena cava became patent, with no contrast agent spillage or residual, and no symptomatic pulmonary embolization. A simultaneous occurrence of oblique adherence and fracture is rarely found in the same filter; however, by using the modified loop-snare technique and biopsy forceps technique, we successfully retrieved the filter and broken pedicle. Our case provides a practical auxiliary technique for regular clinical practice.

Surgical removal of an inferior vena cava filter in the duodenum: A rare case report and literature review

“…It has been observed that asymptomatic patients, who experienced failed percutaneous removal of filters, showed a lower incidence of complications during midterm follow-up, despite significant penetration of the filter strut [ 28 ].A study reported 21 cases where filters were successfully removed through open surgery after failed endovascular attempts. They either experienced rupture of the filter pillar, abdominal pain, or other reasons, but no postoperative complications occurred after undergoing open surgery [ 29 ]. Therefore, the decision to opt for open surgery for filter removal after unsuccessful intracavitary attempts should be informed by a broader spectrum of real-world cases.…”

“…Difficulty arises in dissecting the filter during surgery if the retrieval hook of the filter has not penetrated the vena cava wall. Moreover, if the posterior wall of the vena cava is penetrated, it will be difficult to separate it under laparoscopic surgery [ 29 ].…”

Removal of inferior vena cava filter by open surgery after failure of endovenous retrieval

“…The “Loop snare technique”( 29 ) is often used to correct the tilt of a tapered filter and to retrieve the filter when the retrieval hook is attached to the endothelium. However, the “Loop snare technique” is not successful in retrieving the filter when the retrieval hook is adhered to the inner membrane.…”

Case Report: Endoluminal removal of a conical retrievable superior vena cava filter with a retraction hook attached to the wall

“…ZYLOX filter retrieval kit was introduced but difficulties were encountered when attempting to capture the filter retraction hook. To solve this issue, we utilized a modified loop-snare technique ( 13 ) by introducing a pigtail catheter and a hydrophilic guidewire ( Figure 2E ). The pigtail catheter had its tip partially cut ( Figures 2C,D ) and was rotated to be guided into the interspace between the filter and the SVC wall ( Figure 2B , red arrows).…”