Back to 2016 Karmody Posters

OBJECTIVES: It is estimated that more than 250,000 inferior vena cava (IVC) filters are placed annually in the United States. With the advent of retrievable IVC filters, removal is recommended when the patient is no longer at risk of pulmonary embolism. Retrieval remains technically challenging when the filter is tilted, or part of the filter is embedded or penetrating the IVC wall. Here we demonstrate a novel method to remove IVC filters with the endovascular robot.
METHODS: Proof of concept of robot-assisted filter removal was conducted using a Hansen Magellan Robot, Celect Filter, and Clover Snare in a silicone model of the central venous system. Subsequently, a porcine model with the filter penetrating the wall of the IVC was used to test the robot with satisfactory results. First-in-human filter retrievals with the robot were conducted using ultrasound guided jugular approach with a 9 French robotic system. Two of the filters had legs embedded in the wall of the IVC and were tilted off center. The third filter additionally had the hook embedded in the wall and posed a greater challenge: we employed the “cheese cutter” technique in which a glidewire was used to come around the embedded hook and snared back into the robotic catheter to create a loop with enabled retrieval.
RESULTS: Filters in porcine model and three patients were all retrieved successfully. Completion venograms of all filter removals were satisfactory without extravasation from vena cava.
CONCLUSIONS: First-in-human robot-assisted filter removals are safe and effective. The robot adds a novel and elegant technique for filter retrieval; it enables controlled steering of the snare to remove even the most difficultly positioned filters. Moreover, the robotic system provides an alternative endovascular approach for challenging filter retrievals which ordinarily would require open surgery.