Abstract
Objectives
To evaluate factors associated with increased fluoroscopy time or the need for complex techniques at IVC filter retrieval.
Methods
This is a single-institution retrospective cohort study of 187 consecutive patients who underwent IVC filter retrieval. An analysis was performed on associations of patient factors with increased fluoroscopy time and/or the need for complex retrieval techniques. A complex retrieval was defined as one requiring more than standard sheath and snare technique.
Results
Access vein during filter placement was not associated with filter tilt at placement or removal (p = 0.61 and 0.48). Neither the direction of the hook nor its relationship to the tilt was associated with the need for complex retrieval or increased retrieval fluoroscopy time (p = 0.25, 0.23, p = 0.18, 0.23). Tilt angle at placement correlated with hook apposition at time of removal (p = 0.01). Hook apposition was associated with complex retrieval and increased fluoroscopy time (p < 0.01). Larger tilt angle at placement was not associated with complex retrieval (p = 0.22), but a larger angle at removal was (p < 0.01). Longer dwell time correlated with the need for complex retrieval (p = 0.02). Filter type, sex, and age were not associated with complex retrievals (p = 0.58, p = 0.90, p = 0.99).
Conclusion
Contrary to previous hypotheses and studies, access vein for filter placement did not affect filter tilting, and direction of filter hook–tilt relationship did not affect retrieval fluoroscopy time or the need for complex retrieval techniques. Increased filter placement angle was associated with a larger angle at removal and hook–wall apposition, both of which were associated with complex retrievals.
Key Points
• Filter hook orientation did not correlate with retrieval complexity.
• Filter insertion vein did not correlate with filter tilt.
• Filter tilt and hook apposition to the caval wall at the time of retrieval correlated with retrieval procedure complexity.
Similar content being viewed by others
Abbreviations
- CPT:
-
Current procedural terminology
- DVT:
-
Deep venous thrombosis
- FDA:
-
US Food and Drug Administration
- IVC:
-
Inferior vena cava
- PA:
-
Posteroanterior
- PE:
-
Pulmonary embolism
References
Sarosiek S, Crowther M, Sloan JM (2013) Indications, complications, and management of inferior vena cava filters: the experience in 952 patients at an academic hospital with a level I trauma center. JAMA Intern Med 173:513–517
Van Ha TG, Kang L, Lorenz J et al (2013) Difficult OptEase filter retrievals after prolonged indwelling times. Cardiovasc Intervent Radiol 36:1139–1143
Rajasekhar A, Streiff MB (2013) Vena cava filters for management of venous thromboembolism: a clinical review. Blood Rev 27:225–241
(2014) Removing Retrievable Inferior Vena Cava Filters: FDA safety communication. Available via fda.gov. Accessed April 24, 2017
Dowell JD, Wagner D, Elliott E, Yildiz VO, Pan X (2016) Factors associated with advanced inferior vena cava filter removals: a single-center retrospective study of 203 patients over 7 years. Cardiovasc Intervent Radiol 39:218–226
Zhu X, Tam MD, Bartholomew J, Newman JS, Sands MJ, Wang W (2011) Retrievability and device-related complications of the G2 filter: a retrospective study of 139 filter retrievals. J Vasc Interv Radiol 22:806–812
Iliescu B, Haskal ZJ (2012) Advanced techniques for removal of retrievable inferior vena cava filters. Cardiovasc Intervent Radiol 35:741–750
Al-Hakim R, McWilliams JP, Derry W, Kee ST (2015) The hangman technique: a modified loop snare technique for the retrieval of inferior vena cava filters with embedded hooks. J Vasc Interv Radiol 26:107–110
Kuo WT, Odegaard JI, Louie JD et al (2011) Photothermal ablation with the excimer laser sheath technique for embedded inferior vena cava filter removal: initial results from a prospective study. J Vasc Interv Radiol 22:813–823
Avgerinos ED, Bath J, Stevens J et al (2013) Technical and patient-related characteristics associated with challenging retrieval of inferior vena cava filters. Eur J Vasc Endovasc Surg 46:353–359
Stavropoulos SW, Chen JX, Sing RF et al (2016) Analysis of the final DENALI trial data: a prospective, multicenter study of the Denali inferior vena cava filter. J Vasc Interv Radiol 27 e1531:1531–1538
Dinglasan LA, Oh JC, Schmitt JE, Trerotola SO, Shlansky-Goldberg RD, Stavropoulos SW (2013) Complicated inferior vena cava filter retrievals: associated factors identified at preretrieval CT. Radiology 266:347–354
Al-Hakim R, Kee ST, Olinger K, Lee EW, Moriarty JM, McWilliams JP (2014) Inferior vena cava filter retrieval: effectiveness and complications of routine and advanced techniques. J Vasc Interv Radiol 25:933–939; quiz 940
Malloy PC, Grassi CJ, Kundu S et al (2009) Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 20:S240–S249
Marquess JS, Burke CT, Beecham AH et al (2008) Factors associated with failed retrieval of the Günther tulip inferior vena cava filter. J Vasc Interv Radiol 19:1321–1327
Zhou D, Spain J, Moon E, Mclennan G, Sands MJ, Wang W (2012) Retrospective review of 120 celect inferior vena cava filter retrievals: experience at a single institution. J Vasc Interv Radiol 23:1557–1563
Cohen B, Tang A, Batouli A, Nordman C (2017) How inferior vena cava filter placement approach and filter type predict tilt angle and retrieval. J Vasc Interv Radiol 28(2):S89
Lee MJ, Valenti D, de Gregorio MA, Minocha J, Rimon U, Pellerin O (2015) The CIRSE Retrievable IVC Filter Registry: Retrieval Success Rates in Practice. Cardiovasc Intervent Radiol 38:1502–1507
Geisbüsch P, Benenati JF, Peña CS et al (2012) Retrievable inferior vena cava filters: factors that affect retrieval success. Cardiovasc Intervent Radiol 35:1059–1065
Tsui B, An T, Moon E, King R, Wang W (2016) Retrospective Review of 516 Implantations of Option Inferior Vena Cava Filters at a Single Health Care System. J Vasc Interv Radiol 27:345–353
Gotra ADF, P. Doucet, C. Dey, C. Bessissow, A. Boucher, L. Boucher, L. Valenti, D. (2017) Positional Changes of retrievable inferior vena cava (IVC) filters at time of removal: a comparative study of various filter types and factors that impact retrieval success. Journal of Vascular and Interventional Radiology 28
Bos AS, Tullius T, Patel M et al (2016) Indwelling and Retrieval Complications of Denali and Celect Infrarenal Vena Cava Filters. J Vasc Interv Radiol 27:1021-1026
Funding
The authors state that this work has not received any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Guarantor
The scientific guarantor of this publication is Dr. Mark Kleedehn.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Kaitlin Woo has kindly provided statistical advice for this manuscript.
Informed consent
Written informed consent was waived by the Institutional Review Board.
Ethical approval
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in abstract form in JVIR.
Methodology
• Retrospective
• Observational
• Performed at one institution
Rights and permissions
About this article
Cite this article
Kleedehn, M., Moore, K., Longo, K. et al. An analysis of factors associated with increased fluoroscopy time or the need for complex techniques at IVC filter retrieval. Eur Radiol 29, 1931–1938 (2019). https://doi.org/10.1007/s00330-018-5766-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-018-5766-7