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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

  • Clinical Investigation
  • Venous Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

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.

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Abbreviations

IVC:

Inferior vena cava

CT:

Computed tomography

INR:

International normalized ratio

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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.

Author information

Authors and Affiliations

  1. Department of Radiology, Alfred Health, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia

    Warren Clements, Heather K. Moriarty & Gerard S. Goh

  2. Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia

    Warren Clements & Gerard S. Goh

  3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

    Eldho Paul

  4. Clinical Hematology Department, Alfred Hospital, Melbourne, Australia

    Eldho Paul

Authors
  1. Warren Clements
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  2. Heather K. Moriarty
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  3. Eldho Paul
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  4. Gerard S. Goh
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Corresponding author

Correspondence to Warren Clements.

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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.

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

Level of Evidence

Level 3, retrospective cohort study.

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Clements, W., Moriarty, H.K., Paul, E. et al. 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. Cardiovasc Intervent Radiol 43, 238–245 (2020). https://doi.org/10.1007/s00270-019-02373-9

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  • DOI: https://doi.org/10.1007/s00270-019-02373-9

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