The Wire Loop Technique for Inferior Vena Cava Filter Retrieval
Cassius Iyad Ochoa Chaar, Navid Gholitabar.
Yale University, NEW HAVEN, CT, USA.
OBJECTIVES: The purpose of this video is to demonstrate the retrieval of an inferior vena cava (IVC) filter 4 years after implantation using the wire loop technique.
METHODS: A 60-year-old man with a history of deep vein thrombosis and prothrombin gene mutation presented with back pain for one year. Four years prior, he had a prolonged hospital course with acute respiratory distress syndrome and respiratory failure. He developed iliac vein thrombosis and bleeding duodenal ulcers and received an Eclipse IVC filter (Bard Peripheral Vascular, Tempe, AZ). Since then, he was stable on anticoagulation with no bleeding or recurrence of venous thromboembolism. A CT scan demonstrated a tilted IVC filter with a posterior strut penetrating into the spine.
RESULTS: The patient was placed under general anesthesia in a hybrid operating room. After obtaining right jugular access, venogram demonstrated no thrombus in the filter. A 16 F stiff sheath (Cook Medical Inc, Bloomington, IN) 40cm in length was advanced over an Amplatz wire (Cook Medical Inc, Bloomington, IN). After administration of 3000 units of intravenous heparin, an Omniflush catheter (Angiodynamics, Latham, NY) was reshaped and pulled back to hook around the apex of the IVC filter. An EN snare (Merit Medical, South Jordan, Utah) was introduced in a buddy catheter fashion into the sheath. A soft Glidewire (Terumo Medical Corp, Somerset, NJ) was advanced between the legs of the filter and snared and exteriorized. The Sheath was advanced over the looped wire under direct vision. Meticulous manipulation and traction on the loop was performed under different magnified angles to engage the hook of the IVC filter. Once engaged, significant force with gentle rotation of the sheath releases the fibrosed legs of the IVC filter from the wall of the cava. The patient was discharged the same day and his back pain resolved.
CONCLUSIONS: The wire loop technique is effective for retrieval of titled, fibrosed IVC filter with prolonged dwell time.
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