Novel and Advanced Techniques for Complex IVC Filter Retrieval

Abstract

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.

Migration of an Inferior Vena Cava (IVC) Filter Into the Intrahepatic IVC: A Case Report

“…In 2010 the FDA issued a communication recommending filter removal as soon as possible once its use is no longer indicated, as there is increased morbidity and mortality with retrieval. Daye and Walker recommend that the IVC filter be removed within two months of filter placement or as soon as venous thromboembolism is negligible [4]. Forty to sixty percent of removals can be technically challenging.…”

Precision interventional radiology

“…The retrievable filter greatly reduces the complication of long-term filter implantation, even though two operations under DSA guidance are needed. 19 , 20 …”

“…Owing to the application of deep analysis, data mining, and artificial intelligence analysis as well as molecular imaging, multimodal imaging, and multi-omics, the concept of precision diagnosis consists of both morphological and pathophysiological diagnoses. 19 , 21 Precision diagnosis also reflects the occurrence, development, and prognosis of diseases. With interventional therapies based on precision diagnosis, the goal of maximizing patients’ benefit and minimizing damage can be realized.…”

The Clinical Rationale for the Sentry Bioconvertible Inferior Vena Cava Filter for the Prevention of Pulmonary Embolism

“…Recent reviews have analyzed standard and advanced techniques for achieving IVC filter retrieval, including such methods as laser thermal and endobronchial forceps dissection [50, 53, 54]. Case reports have described open surgical removal of IVC filters, a last resort for patients with symptoms referable to filter strut penetration, such as chronic back and abdominal pain, after failed endovascular attempts [55].…”