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Stratification of Pre-procedure Risk Factors Associated with Difficult-to-remove Inferior Vena Cava (IVC) Filters: A 6-year Retrospective Analysis at a Tertiary Center

  • Warren ClementsEmail author
  • Heather K. Moriarty
  • Eldho Paul
  • Gerard S. Goh
Clinical Investigation Venous Interventions
  • 23 Downloads
Part of the following topical collections:
  1. Venous Interventions

Abstract

Purpose

Currently, data surrounding predicting difficulty of IVC filter retrievals are heterogenous and conflicting. We aimed to identify which of many variables associated with IVC filters is a risk for procedural difficulty.

Materials and Methods

This study retrospectively reviewed 6 years of IVC filter retrievals at a tertiary center identifying 356 consecutive retrievals. A difficult retrieval was defined as any case where the fluoroscopy time exceeded 7 min, an advanced technique was required, the retrieval attempt failed and required an additional attempt or was left permanent, or there was major complication such as IVC filter fracture/migration/vessel injury.

Results

There were 105 filter retrievals defined as difficult (29.5%). Univariate analysis showed significantly increased risk for retrievals with an embedded top. Multivariate analysis assessed the association between dwell time, tilt, age, non-hooked filters, leg penetration and difficult retrieval. This showed a significant increase in the difficulty of retrieval for filters tilted between 5° and 15° (odds ratio 2.38, p < 0.001), for filters tilted more than 15° (odds ratio 7.91, p < 0.001), and dwell time greater than 6 months (odds ratio 2.06, p = 0.033). No significant increase in difficulty was seen with filters with a dwell time of less than 6 months, leg penetration, non-hooked filters, or with increasing patient age.

Conclusions

Identifying these risks in patients in advance of the procedure allows appropriate planning and improved workflow efficiency.

Keywords

IVC Inferior vena cava Filter Angiogram Venogram 

Abbreviations

IVC

Inferior vena cava

CT

Computed tomography

INR

International normalized ratio

Notes

Acknowledgements

The team would like to acknowledge the following doctors who were also involved in the management of these patients: Dr Jim Koukounaras, Dr Tim Joseph, Dr Tuan Phan, Dr Kelvin Stribley, and A/Prof Stuart Lyon.

Funding

This study was not supported by any funding.

Compliance with Ethical Standard

Conflict of interest

Dr Gerard S Goh discloses an industry relationship with Cook Medical which has no association with this manuscript. The remaining authors have no disclosures.

Ethical Approval

Approval was obtained by The Alfred Human Research and Ethics Committee prior to performing this study.

Informed Consent

For this type of study, formal consent is not required.

Consent for Publication

For this type of study, consent for publication is not required.

Level of Evidence

Level 3, retrospective cohort study.

References

  1. 1.
    Minocha J, Idakoji I, Riaz A, et al. Improving inferior vena cava filter retrieval rates: impact of a dedicated inferior vena cava filter clinic. J Vasc Interv Radiol. 2010;21(12):1847–51.CrossRefGoogle Scholar
  2. 2.
    Angel LF, Tapson V, Galgon RE, Restrepo MI, Kaufman J. Systematic review of the use of retrievable inferior vena cava filters. J Vasc Interv Radiol. 2011;22(11):1522–30.  https://doi.org/10.1016/j.jvir.2011.08.024.CrossRefPubMedGoogle Scholar
  3. 3.
    Clements W. Inferior vena cava filters in the asymptomatic chronically occluded cava: to remove or not remove? Cardiovasc Intervent Radiol. 2019;42:165.  https://doi.org/10.1007/s00270-018-2077-y.CrossRefPubMedGoogle Scholar
  4. 4.
    Lee JT, Goh GS, Joseph T, et al. Prolonged balloon tamponade in the initial management of inferior vena cava injury following complicated filter retrieval, without the need for surgery. J Med Imaging Radiat Oncol. 2018;62:810–3.  https://doi.org/10.1111/1754-9485.12758.CrossRefPubMedGoogle Scholar
  5. 5.
    Dinglasan LA, Oh JC, Schmitt JE, Trerotola SO, Shlansky-Goldberg RD, Stavropoulos SW. Complicated inferior vena cava filter retrievals: associated factors identified at preretrieval CT. Radiology. 2013;266:347–54.  https://doi.org/10.1148/radiol.12120372.CrossRefPubMedGoogle Scholar
  6. 6.
    Desai K, Laws J, Salem R, Mouli S, Errea M, Karp J, et al. Defining prolonged dwell time: when are advanced inferior vena cava filter retrieval techniques necessary? Circ Cardiovasc Interv. 2017;10(6):e003957.CrossRefGoogle Scholar
  7. 7.
    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. 2019;29:1931.  https://doi.org/10.1007/s00330-018-5766-7.CrossRefPubMedGoogle Scholar
  8. 8.
    Sag AA, Stavas JM, Burke CT, Dixon RG, Marquess JS, Mauro MA. Analysis of tilt of the Günther tulip filter. J Vasc Interv Radiol. 2008;19(5):669–76.CrossRefGoogle Scholar
  9. 9.
    Vijay K, Hughes JA, Burdette AS, Scorza LB, Singh H, Waybill PN, Lynch FC. Fractured bard recovery, G2, and G2 express inferior vena cava filters: incidence, clinical consequences, and outcomes of removal attempts. J Vasc Interv Radiol. 2012;23(2):188–94.  https://doi.org/10.1016/j.jvir.2011.10.005.CrossRefPubMedGoogle Scholar
  10. 10.
    Geisbusch P, Benenati JF, Pena CS, Couvillon J, Powell A, Gandhi R, Samuels S, Uthoff H. Retrievable inferior vena cava filters: factors that affect retrieval success. Cardiovasc Intervent Radiol. 2012;35:1059–65.  https://doi.org/10.1007/s00270-011-0268-x.CrossRefPubMedGoogle Scholar
  11. 11.
    Avgerinos ED, Bath J, Stevens J, et al. Technical and patient-related characteristics associated with challenging retrieval of inferior vena cava filters. Eur J Vasc Endovasc Surg. 2013;46(3):353–9.  https://doi.org/10.1016/j.ejvs.2013.06.007.CrossRefPubMedGoogle Scholar
  12. 12.
    Marquess JS, Burke CT, Beecham AH, et al. Factors associated with failed retrieval of the Günther tulip inferior vena cava filter. J Vasc Interv Radiol. 2008;19(9):1321–7.  https://doi.org/10.1016/j.jvir.2008.06.004.CrossRefPubMedGoogle Scholar
  13. 13.
    Kassamali RH, Burlak K, Lee JTL, Aberdein G, Harisis G, Goh GS, Kavnoudias H, Clements W. The safety of continuing therapeutic anticoagulation during inferior vena cava filter retrieval: A 6-year retrospective review from a tertiary centre. Cardiovasc Intervent Radiol. 2019;42:1110.  https://doi.org/10.1007/s00270-019-02254-1.CrossRefPubMedGoogle Scholar
  14. 14.
    Schmelzer TM, Christmas AB, Taylor DA, et al. Vena cava filter retrieval in therapeutically anticoagulated patients. Am J Surg. 2008;196(6):944–6.CrossRefGoogle Scholar
  15. 15.
    Magee GA, Bartley MG, Plotkin A, et al. Inferior vena cava filter resulting in perforation and massive retroperitoneal hematoma presenting as acute onset of lower extremity weakness. Ann Vasc Surg. 2019;57:48e13–e17.CrossRefGoogle Scholar
  16. 16.
    Iliescu B, Haskal ZJ. Advanced techniques for removal of retrievable inferior vena cava filters. Cardiovasc Intervent Radiol. 2012;35:741.  https://doi.org/10.1007/s00270-011-0205-z.CrossRefPubMedGoogle Scholar
  17. 17.
    Kuo WT, Tong RT, Hwang GL, et al. High-risk retrieval of adherent and chronically implanted IVC filters: techniques for removal and management of thrombotic complications. J Vasc Interv Radiol. 2009;20(12):1548–56.CrossRefGoogle Scholar
  18. 18.
    Kuyumcu G, Walker TG. Inferior vena cava filter retrievals, standard and novel techniques. Cardiovasc Diagn Ther. 2016;6(6):642–50.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of RadiologyAlfred Health, Alfred HospitalMelbourneAustralia
  2. 2.Department of Surgery, Central Clinical SchoolMonash UniversityMelbourneAustralia
  3. 3.Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  4. 4.Clinical Hematology DepartmentAlfred HospitalMelbourneAustralia

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