Factors Predicting Failure of Retrieval of Inferior Vena Cava (IVC) Filters
Katherine L. Morrow, MS1, James Bena, MS2, Sean P. Lyden, MD2, Ezequiel Parodi, MD2, Christopher J. Smolock, MD2.
1Case Western Reserve University School of Medicine, Cleveland, OH, USA, 2Cleveland Clinic Department of Vascular Surgery, Cleveland, OH, USA.
IVC filters are commonly used to prevent pulmonary embolism (PE) in patients with DVT. However, IVC filters are associated with risks including IVC perforation, filter migration, fracture, and thrombosis. Filter retrieval is not always successful. Our objective was to identify factors associated with failure of retrieval of IVC filters.
This study is an IRB-approved retrospective chart review of patients undergoing IVC filter retrieval attempts in the Department of Vascular Surgery at The Cleveland Clinic from 2011-2018. Patients were identified by ICD code query and data was gathered regarding demographics, filter position, procedure details, and patient outcomes. CT imaging and venography was used to determine IVC filter location prior to retrieval.
We identified 295 filter retrieval attempts in 294 patients. There were no procedural IVC ruptures, morbidity, or mortality. Retrieval was successful for 249 (84.4%) of filters. Median filter dwell time was 196 days in successful retrievals compared to 375 days in failed retrieval attempts (P=0.004). Penetration of filter tines through the caval wall occurred in 291 (98.6%) of filters. However, the hook/apex (HA) of 31 (10.5%) were embedded or penetrating through the caval wall; the hook/apex and collar (HA+C) of 33 (11.2%) were embedded or through the caval wall. The failure rate of retrieval of filters with HA embedded was 48.4% (15/31), with HA+C 66.7% (22/33), and without these issues 3.9% (9/231). The failure rate of HA as well as HA+C was higher than that of those without these issues (P<0.001) but did not differ from one another (P=0.14). Among those with CT scans, association of any portion of the filter with other adjacent retroperitoneal structures was not related to an increased rate of failed retrieval (P=0.16). Complex retrieval methods involving endobronchial forceps, ballooning, or snaring the collar of the filter was associated with increased failure of retrieval compared to simple retrieval involving snaring the hook of the filter (P<0.001). Failure rates decreased over time (P=0.004). 8% of patients with failed retrieval attempts had subsequent venous thromboembolism.
Retrieval attempts should be made for all IVC filters irrespective of chronicity and complexity given the procedural safety. Tine penetration is nearly ubiquitous but IVC filters with HA or HA+C imbedded into or penetrating through the caval wall are predictors of retrieval failure.
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