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
Part of the following topical collections:
  1. Venous Interventions



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.


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.


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


IVC Inferior vena cava Filter Angiogram Venogram 



Inferior vena cava


Computed tomography


International normalized ratio



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.


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.


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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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