PS178. Leave ‘Em or Retrieve’ Em? Management of Inferior Vena Cava Filters

Abstract

retrieval that can be used when standard snaring is unsuccessful have been recently described. The purpose of this study is to analyze how incorporation of these new techniques impacted the outcomes of IVCF retrievals at our institution over the past 5 years.Methods: Data from all patients undergoing IVCF removal by vascular surgeons at a tertiary academic medical center between 2009 and 2013 were collected, including demographics, procedural and filter characteristics. A standard technique of snaring the retrieval hook was attempted first in all cases; if unsuccessful, a number of "fall-back" techniques were employed, including the use of endoscopic graspers, 18F sheaths, and snaring a second wire below the collar of the filter to collapse it into the sheath.Results: A total of 274 patients underwent attempted IVCF retrieval; three were excluded intraoperatively due to thrombus in the filter. Most filters were Gunther Tulips (99%), 71% had been placed prophylactically prior to bariatric surgery. A total of 267 (98.5%) filters were retrieved successfully, 212 (79%) using standard snaring and 55 (21%) with "fall-back" techniques. In patients undergoing "fall-back" techniques, technical success was achieved 100% of the time. The median time since insertion was significantly longer in the "fall-back" group (173 days vs 70 days; P < .0001). Three intraoperative complications occurred: fractured wires embolized to the right atrium or pulmonary artery and were successfully removed endovascularly. The majority of the procedures (80%) were safely performed under sedation in both groups.Conclusions: Incorporation of "fall-back" techniques may allow 100% technically successful and safe removal of retrievable IVC filters, and is especially useful in removing filters with prolonged dwell time.