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OBJECTIVE: Although most inferior vena cava (IVC) filters placed today are designed for temporary use, published rates of retrieval remain low. Prolonged dwelling times and filter malposition can make extraction by standard techniques challenging. This series details our experience with several advanced techniques that facilitate removal of malpositioned filters.
METHODS: We identified fourteen patients between 1/1/2009 and 8/31/2011 who required adjunctive techniques for filter removal. These techniques included the use of: shaped catheters for snare guidance, deflectable tip wires, deflectable tip sheaths, balloon angioplasty, and grasping forceps.
RESULTS: The average patient age at the time of retrieval was 51.5 years (33-74 years). Twenty-one percent were male. The indication for initial filter placement was prophylaxis in 36%, contraindication to anticoagulation in the setting of DVT/PE in 43%, and failure of anticoagulation in 21%. The filter types included: Bard G2 (67%), Bard Eclipse (8%) and Cook Celect (25%). The average time to filter retrieval was 422 days (86-1962 days). All of the filters were tilted in the IVC and 11 (79%) demonstrated legs that penetrated the IVC on preprocedural imaging. Techniques used to aid in removal of these filters included: snare directed by shaped catheter (79%), deflectable tip sheath (43%), balloon angioplasty (43%), deflectable tip wire (36%), and grasping forceps (29%). Forty-three percent of patients required placement of more than 1 sheath to facilitate removal and 29% of patients required >3 techniques for successful removal. There were no deaths or IVC occlusions identified in follow-up.
CONCLUSIONS: Endovascular removal of most tipped and perforating IVC filters can be safely accomplished by gradually employing a combination of complex retrieval methods. The techniques described represent important adjuncts to the standard snare method, and will allow for a higher retrieval rate in most patients.