Complex Retrieval of Embedded IVC Filters: Alternative Techniques and Histologic Tissue Analysis

Kuo, William T.; Cupp, John S.; Louie, John D.; Kothary, Nishita; Hofmann, Lawrence V.; Sze, Daniel Y.; Hovsepian, David M.

doi:10.1007/s00270-011-0175-1

Cited by 65 publications

(41 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Endothelialization of filter components occurs where there is contact between the filter and the caval wall; if this involves the filter apex and hook, an endothelial cap forms over these components. Histological studies have shown that the tissue formed between the filter and the IVC eventually becomes mostly fibrotic, thereby rendering standard retrieval techniques ineffective for filter removal (19). Additionally during retrieval attempts the fibrotic tissue that adheres the filter to the IVC wall may lead to mechanical complications such as filter fragmentation and IVC injury.…”

Section: Discussionmentioning

confidence: 99%

“…Traction forces using the previously described methods may fail to separate the embedded filter from contact with the caval wall (19). The double guidewire and snare technique involves using an additional guidewire and snare to utilize the previously described guidewire loop and snare technique via two separate venous accesses (16).…”

Section: Dual-access Techniques Double Guidewire and Snare Techniquementioning

confidence: 99%

See 1 more Smart Citation

Inferior vena cava filter retrievals, standard and novel techniques

Kuyumcu¹,

Walker²

2016

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Dual-access Techniques Double Guidewire and Snare Techniquementioning

confidence: 99%

Inferior vena cava filter retrievals, standard and novel techniques

Kuyumcu¹,

Walker²

2016

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

show abstract

“…2 However, despite heightened awareness and closer follow-up to remove these devices, it is estimated that up to 40% to 60% of retrievable-type filters cannot be removed using standard methods, 1,3,4 especially after 1 year of implantation. 3 For instance, if 40% of the 250 000 retrievable-type filters placed annually 2 cannot be removed, then 100 000 patients per year could develop an embedded filter in the United States alone.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this heightened awareness, it is estimated that as many as 40% to 60% of retrievable-type filters cannot be removed using standard methods alone because they have become firmly embedded. 1,4 In addition, many patients have undergone placement of a permanent-type filter designed to permanently embed into the vessel wall. Although these patients may also develop filter-related morbidity after chronic implantation, there is currently no routine option for removing permanent-type filters.…”

mentioning

confidence: 99%

Excimer Laser–Assisted Removal of Embedded Inferior Vena Cava Filters

Kuo

Odegaard

Rosenberg

et al. 2013

Circ: Cardiovascular Interventions

Self Cite

View full text Add to dashboard Cite

Background-Although chronically implanted inferior vena cava filters may result in filter-related morbidity, there is currently no routine option for removing such filters when they become firmly embedded along the vena cava endothelium. Methods and Results-During a 3-year period, 100 consecutive patients were prospectively enrolled in a single-center study. There were 42 men and 58 women (mean age, 46 years; limits, 18-76 years). Retrieval indications included filterrelated acute inferior vena cava thrombosis, chronic inferior vena cava occlusion, and pain from retroperitoneal or bowel penetration. Filter retrieval was also performed to prevent risks from prolonged implantation and to potentially eliminate the need for lifelong anticoagulation. After standard methods failed, photothermal tissue ablation was attempted with a laser sheath powered by a 308-nm xenon chloride excimer laser. Applied forces were recorded with a digital tension meter before and during laser activation. Laser-assisted retrieval was successful in 98.0% (95% confidence interval [CI], 93.0%-99.8%) with mean implantation of 855 days (limits, 37-6663 days; >18 years). The following filter types were encountered in this study: Günther-Tulip (n=34), Celect (n=12), Option (n=17), Optease (n=20, 1 failure), TrapEase (n=6, 1 failure), Simon-Nitinol (n=1), 12F Stainless Steel Greenfield (n=4), and Titanium Greenfield (n=6). The average force during failed standard retrievals was 7.2 versus 4.6 pounds during laser-assisted retrievals (P<0.0001). The major complication rate was 3.0% (95% CI, 0.6%-8.5%), the minor complication rate was 7.0% (95% CI, 0.3%-13.9%), and there were 4 adverse events (2 coagulopathic hemorrhages, 1 renal infarction, and 1 cholecystitis; 4.0%; 95% CI, 1.1%-9.9%) at mean follow-up of 500 days (limits, 84-1079 days). Scar tissue ablation was histologically confirmed in 96.0% (95% CI, 89.9%-98.9%). Successful retrieval allowed cessation of anticoagulation in 30 of 30 (100%) patients and alleviated morbidity in 23 of 24 patients (96%). Conclusions-Excimer laser-assisted removal is effective in removing embedded inferior vena cava filters refractory to standard retrieval and high force. This method can be safely used to prevent and alleviate filter-related morbidity. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01158482.

show abstract

“…A recent study assessed the underlying tissue histology in ten cases of complicated filter retrievals so as to better characterize the pathology of chronic filter implantations [19]. Histological analysis from tissue adherent to the extracted filters reveals early adherence of acute clot and fibrin to the filter, progressing into extensive neointimal hyperplasia and dense fibrosis with prolonged dwell times.…”

Section: Pathophysiology Of Complicated Filter Retrievalsmentioning

confidence: 99%

Novel and Advanced Techniques for Complex IVC Filter Retrieval

Daye

Walker

2017

Curr Treat Options Cardio Med

View full text Add to dashboard Cite

Inferior vena cava (IVC) filter placement is indicated for the treatment of venous thromboembolism (VTE) in patients with a contraindication to or a failure of anticoagulation. With the advent of retrievable IVC filters and their ease of placement, an increasing number of such filters are being inserted for prophylaxis in patients at high risk for VTE. Available data show that only a small number of these filters are retrieved within the recommended period, if at all, prompting the FDA to issue a statement on the need for their timely removal. With prolonged dwell times, advanced techniques may be needed for filter retrieval in up to 60% of the cases. In this article, we review standard and advanced IVC filter retrieval techniques including single-access, dual-access, and dissection techniques. Complicated filter retrievals carry a non-negligible risk for complications such as filter fragmentation and resultant embolization of filter components, venous pseudoaneurysms or stenoses, and breach of the integrity of the caval wall. Careful pre-retrieval assessment of IVC filter position, any significant degree of filter tilting or of hook, and/or strut epithelialization and caval wall penetration by filter components should be considered using dedicated cross-sectional imaging for procedural planning. In complex cases, the risk for retrieval complications should be carefully weighed against the risks of leaving the filter permanently indwelling. The decision to remove an embedded IVC filter using advanced techniques should be individualized to each patient and made with caution, based on the patient's age and existing comorbidities.

show abstract

Complex Retrieval of Embedded IVC Filters: Alternative Techniques and Histologic Tissue Analysis

Cited by 65 publications

References 18 publications

Inferior vena cava filter retrievals, standard and novel techniques

Inferior vena cava filter retrievals, standard and novel techniques

Excimer Laser–Assisted Removal of Embedded Inferior Vena Cava Filters

Novel and Advanced Techniques for Complex IVC Filter Retrieval

Contact Info

Product

Resources

About