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TITLE: Novel yet Straightforward Techniques for Complicated Inferior Vena Cava Filter Retrieval
OBJECTIVE: While 85% of temporary IVC filters are successfully retrieved, there remain a significant percentage of filters that are unable to be removed with a simple snare approach. We describe novel techniques that will aid in the surgeon’s attempts at complicated IVC filter retrievals.
METHODS: IVC filter retrieval at our institution is initially attempted from an internal jugular vein approach with a classic snare technique. Complicated filter retrievals are those that have failed traditional snare techniques, have significant tilt, or whose hooks rest against the IVC wall.
RESULTS: The most common challenge typically relates to an angulated filter (Figure 1). One novel technique employed is to place a stiff buddy wire (Amplatz) down alongside the filter (Figure 2). The stiff wire aids in redirecting the retrieval sheath to more closely approximate the location of the filter hook against the IVC wall. While there have been reports of balloon deployments to push the hook away from the IVC wall, we describe an aggressive pullback technique to ‘right’ an angulated filter (Figure 3). In this novel technique, we deploy a balloon above the filter (opposite the side of the hook and wall interface) from the femoral access. Then by pulling the inflated balloon back, against the filter struts, the filter ‘rights’ itself making the filter hook drift into a more central location in the IVC.
CONCLUSIONS: These two novel techniques of aiding in IVC filter retrieval are straightforward approaches that any vascular or general surgeon can employ and have decreased the number of unsuccessful IVC filter retrievals in our institution.