CardioVascular and Interventional Radiology

, Volume 35, Issue 3, pp 588–597 | Cite as

Complex Retrieval of Embedded IVC Filters: Alternative Techniques and Histologic Tissue Analysis

  • William T. Kuo
  • John S. Cupp
  • John D. Louie
  • Nishita Kothary
  • Lawrence V. Hofmann
  • Daniel Y. Sze
  • David M. Hovsepian
Clinical Investigation

Abstract

Purpose

We evaluated the safety and effectiveness of alternative endovascular methods to retrieve embedded optional and permanent filters in order to manage or reduce risk of long-term complications from implantation. Histologic tissue analysis was performed to elucidate the pathologic effects of chronic filter implantation.

Methods

We studied the safety and effectiveness of alternative endovascular methods for removing embedded inferior vena cava (IVC) filters in 10 consecutive patients over 12 months. Indications for retrieval were symptomatic chronic IVC occlusion, caval and aortic perforation, and/or acute PE (pulmonary embolism) from filter-related thrombus. Retrieval was also performed to reduce risk of complications from long-term filter implantation and to eliminate the need for lifelong anticoagulation. All retrieved specimens were sent for histologic analysis.

Results

Retrieval was successful in all 10 patients. Filter types and implantation times were as follows: one Venatech (1,495 days), one Simon-Nitinol (1,485 days), one Optease (300 days), one G2 (416 days), five Günther-Tulip (GTF; mean 606 days, range 154–1,010 days), and one Celect (124 days). There were no procedural complications or adverse events at a mean follow-up of 304 days after removal (range 196–529 days). Histology revealed scant native intima surrounded by a predominance of neointimal hyperplasia and dense fibrosis in all specimens. Histologic evidence of photothermal tissue ablation was confirmed in three laser-treated specimens.

Conclusion

Complex retrieval methods can now be used in select patients to safely remove embedded optional and permanent IVC filters previously considered irretrievable. Neointimal hyperplasia and dense fibrosis are the major components that must be separated to achieve successful retrieval of chronic filter implants.

Keywords

Inferior vena cava filter (IVF) placement Laser treatment Vena cava Venous intervention 

Notes

Conflict of interest

W.T. Kuo is on the scientific advisory board as a paid consultant for Veniti Medical. None of the other authors has identified a conflict of interest.

References

  1. 1.
    Ray CE (2006) Outcomes with retrievable inferior vena cava filters: a multicenter study. J Vasc Interv Radiol 17:1595–1604PubMedCrossRefGoogle Scholar
  2. 2.
    Kuo WT, Tong RT, Hwang GL et al (2009) High-risk retrieval of adherent and chronically implanted IVC filters: techniques for removal and management of thrombotic complications. J Vasc Interv Radiol 20:1548–1556PubMedCrossRefGoogle Scholar
  3. 3.
    PREPIC Study Group (2005) Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism. The PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 112:416–422CrossRefGoogle Scholar
  4. 4.
    Kuo WT, Bostaph AS, Loh CT et al (2006) Retrieval of trapped Günther Tulip inferior vena cava filters: snare-over-guide wire loop technique. J Vasc Interv Radiol 17:1845–1849PubMedCrossRefGoogle Scholar
  5. 5.
    Stavropoulos SW, Dixon RG, Burke CT et al (2008) Embedded inferior vena cava filter removal: use of endobronchial forceps. J Vasc Interv Radiol 19:1297–1301PubMedCrossRefGoogle Scholar
  6. 6.
    Kuo WT, Cupp JS (2010) The excimer laser sheath technique for embedded inferior vena cava filter removal. J Vasc Interv Radiol 21:1896–1899PubMedCrossRefGoogle Scholar
  7. 7.
    Turba UC, Arslan B, Meuse M et al (2010) Günter Tulip filter retrieval experience: predictors of successful retrieval. Cardiovasc Interv Radiol 33:732–738CrossRefGoogle Scholar
  8. 8.
    Looby S, Given MF, Geoghegan T et al (2007) Günther Tulip retrievable inferior vena caval filters: indications, efficacy, retrieval, and complications. Cardiovasc Interv Radiol 30:59–65CrossRefGoogle Scholar
  9. 9.
    Van Ha TG, Chien AS, Funaki BS et al (2008) Use of retrievable compared to permanent inferior vena cava filters: a single-institution experience. Cardiovasc Interv Radiol 31:308–315CrossRefGoogle Scholar
  10. 10.
    Saito N, Shimamoto T, Takeda T et al (2010) Excimer laser-assisted retrieval of Günther Tulip vena cava filters: a pilot study in a canine model. J Vasc Interv Radiol 21:719–724PubMedCrossRefGoogle Scholar
  11. 11.
    Gijsbers GH, van den Broecke DG, Sprangers RL, van Gamert MJ (1992) Effect of force on ablation depth for a XeCl excimer laser beam delivered by an optical fiber in contact with arterial tissue under saline. Lasers Surg Med 12:576–584PubMedCrossRefGoogle Scholar
  12. 12.
    van Leeuwen TG, Borst C (1996) Fundamental laser–tissue interactions. Semin Intervent Cardiol 1:16–68Google Scholar
  13. 13.
    van Leeuwen TG, Jansen ED, Welch AJ, Borst C (1996) Excimer laser induced bubble dimensions, theory and implications for laser angioplasty. Lasers Surg Med 18:381–390PubMedCrossRefGoogle Scholar
  14. 14.
    Oraevsky AA, Jacques SL, Pettit GH et al (1992) XeCl laser ablation of atherosclerotic aorta: optical properties and energy pathways. Lasers Surg Med 12:585–597PubMedCrossRefGoogle Scholar
  15. 15.
    Reiser C, Taylor K, Lippincott R (1998) Large laser sheaths for pacing and defibrillator lead removal. Lasers Surg Med 22:42–45PubMedCrossRefGoogle Scholar
  16. 16.
    Wilkoff BL, Byrd CL, Love CJ et al (1999) Pacemaker lead extraction with the laser sheath: results of the Pacing Lead Extraction with the Excimer Sheath (PLEXES) trial. J Am Coll Cardiol 33:1671–1676PubMedCrossRefGoogle Scholar
  17. 17.
    Brountzos EN, Kaufman JA, Venbrux AC et al (2003) A new optional vena cava filter: retrieval at 12 weeks in an animal model. J Vasc Interv Radiol 14:763–772PubMedCrossRefGoogle Scholar
  18. 18.
    Binkert CA, Morash MC, Gates JD (2007) Venographic findings at retrieval of inferior vena cava filters. AJR Am J Roentgenol 188:1039–1043PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011

Authors and Affiliations

  • William T. Kuo
    • 1
  • John S. Cupp
    • 2
  • John D. Louie
    • 1
  • Nishita Kothary
    • 1
  • Lawrence V. Hofmann
    • 1
  • Daniel Y. Sze
    • 1
  • David M. Hovsepian
    • 1
  1. 1.Division of Vascular and Interventional Radiology, Department of RadiologyStanford University Medical CenterStanfordUSA
  2. 2.Department of PathologyStanford University Medical CenterStanfordUSA

Personalised recommendations