Skip to main content
SpringerLink
Log in

Novel and Advanced Techniques for Complex IVC Filter Retrieval

  • Vascular Disease (I Weinberg, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Inferior vena cava (IVC) filter placement is indicated for the treatment of venous thromboembolism (VTE) in patients with a contraindication to or a failure of anticoagulation. With the advent of retrievable IVC filters and their ease of placement, an increasing number of such filters are being inserted for prophylaxis in patients at high risk for VTE. Available data show that only a small number of these filters are retrieved within the recommended period, if at all, prompting the FDA to issue a statement on the need for their timely removal. With prolonged dwell times, advanced techniques may be needed for filter retrieval in up to 60% of the cases. In this article, we review standard and advanced IVC filter retrieval techniques including single-access, dual-access, and dissection techniques. Complicated filter retrievals carry a non-negligible risk for complications such as filter fragmentation and resultant embolization of filter components, venous pseudoaneurysms or stenoses, and breach of the integrity of the caval wall. Careful pre-retrieval assessment of IVC filter position, any significant degree of filter tilting or of hook, and/or strut epithelialization and caval wall penetration by filter components should be considered using dedicated cross-sectional imaging for procedural planning. In complex cases, the risk for retrieval complications should be carefully weighed against the risks of leaving the filter permanently indwelling. The decision to remove an embedded IVC filter using advanced techniques should be individualized to each patient and made with caution, based on the patient’s age and existing comorbidities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol. 2008;28(3):370–2. doi:10.1161/ATVBAHA.108.162545.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Cushman M, Tsai AW, White RH, Heckbert SR, Rosamond WD, Enright P, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med. 2004;117(1):19–25. doi:10.1016/j.amjmed.2004.01.018.

    Article  PubMed  Google Scholar 

  3. Moore PS, Andrews JS, Craven TE, Davis RP, Corriere MA, Godshall CJ, et al. Trends in vena caval interruption. J Vasc Surg. 2010;52(1):118–25. doi:10.1016/j.jvs.2009.09.067. e3; discussion 25-6.

    Article  PubMed  Google Scholar 

  4. Garcia-Godoy F, Collins T, Sacks D, Vasas S, Sarani B. Retrieval of inferior vena cava filters after prolonged indwelling time. Arch Intern Med. 2011;171(21):1953–5. doi:10.1001/archinternmed.2011.526.

    Article  PubMed  Google Scholar 

  5. 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.e3. doi:10.1016/j.jvir.2011.08.024.

    Article  PubMed  Google Scholar 

  6. FDA. Removing retrievable inferior vena cava filters: FDA safety communication http://www.fda.gov/MedicalDevices/Safety/Date accessed November/5/2016.

  7. Stein PD, Alnas M, Skaf E, Kayali F, Siddiqui T, Olson RE, et al. Outcome and complications of retrievable inferior vena cava filters. Am J Cardiol. 2004;94(8):1090–3. doi:10.1016/j.amjcard.2004.06.077.

    Article  PubMed  Google Scholar 

  8. • Sarosiek S, Crowther M, Sloan JM. 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. 2013;173(7):513–7. doi:10.1001/jamainternmed.2013.343. Important article highlighting the longitudinal experience with IVC filters in a relatively large study population.

    Article  PubMed  Google Scholar 

  9. Van Ha TG, Chien AS, Funaki BS, Lorenz J, Piano G, Shen M, et al. Use of retrievable compared to permanent inferior vena cava filters: a single-institution experience. Cardiovasc Interv Radiol. 2007;31(2):308–15. doi:10.1007/s00270-007-9184-5.

    Google Scholar 

  10. Johnson MS, Nemcek AA, Benenati JF, Baumann DS, Dolmatch BL, Kaufman JA, et al. The safety and effectiveness of the retrievable option inferior vena cava filter: a United States prospective multicenter clinical study. J Vasc Interv Radiol. 2010;21(8):1173–84. doi:10.1016/j.jvir.2010.04.004.

    Article  PubMed  Google Scholar 

  11. Lyon SM, Riojas GE, Uberoi R, Patel J, Lipp MEB, Plant GR, et al. Short- and long-term retrievability of the Celect vena cava filter: results from a multi-institutional registry. J Vasc Interv Radiol. 2009;20(11):1441–8. doi:10.1016/j.jvir.2009.07.038.

    Article  PubMed  Google Scholar 

  12. Kaufman JA, Kinney TB, Streiff MB, Sing RF, Proctor MC, Becker D, et al. Guidelines for the use of retrievable and convertible vena cava filters: report from the society of interventional radiology multidisciplinary consensus conference. J Vasc Interv Radiol. 2006;17(3):449–59. doi:10.1097/01.rvi.0000203418-39769.0d.

    Article  PubMed  Google Scholar 

  13. Kirilcuk NN, Herget EJ, Dicker RA, Spain DA, Hellinger JC, Brundage SI. Are temporary inferior vena cava filters really temporary? Am J Surg. 2005;190(6):864–70. doi:10.1016/j.amjsurg.2005.08.009.

    Article  Google Scholar 

  14. • Al-Hakim R, Kee ST, Olinger K, Lee EW, Moriarty JM, McWilliams JP. Inferior vena cava filter retrieval: effectiveness and complications of routine and advanced techniques. J Vasc Interv Radiol. 2014;25(6):933–9. doi:10.1016/j.jvir.2014.01.019. Recent article comparing the effectiveness and complications of standard and advanced IVC filter retrieval techniques.

    Article  PubMed  Google Scholar 

  15. Stavropoulos SW, Solomon JA, Trerotola SO. Wall-embedded recovery inferior vena cava filters: imaging features and technique for removal. J Vasc Interv Radiol. 2006;17(2):379–82. doi:10.1097/01.rvi.0000196354.45643.5a.

    Article  PubMed  Google Scholar 

  16. Iliescu B, Haskal ZJ. Advanced techniques for removal of retrievable inferior vena cava filters. Cardiovasc Interv Radiol. 2011;35(4):741–50. doi:10.1007/s00270-011-0205-z.

    Article  Google Scholar 

  17. Van Ha TG, Vinokur O, Lorenz J, Regalado S, Zangan S, Piano G, et al. Techniques used for difficult retrievals of the Günther Tulip inferior vena cava filter: experience in 32 patients. J Vasc Interv Radiol. 2009;20(1):92–9. doi:10.1016/j.jvir.2008.10.007.

    Article  PubMed  Google Scholar 

  18. Oh JC, Trerotola SO, Dagli M, Shlansky-Goldberg RD, Soulen MC, Itkin M, et al. Removal of retrievable inferior vena cava filters with computed tomography findings indicating tenting or penetration of the inferior vena cava wall. J Vasc Interv Radiol. 2011;22(1):70–4. doi:10.1016/j.jvir.2010.09.021.

    Article  PubMed  Google Scholar 

  19. Kuo WT, Cupp JS, Louie JD, Kothary N, Hofmann LV, Sze DY, et al. Complex retrieval of embedded IVC filters: alternative techniques and histologic tissue analysis. Cardiovasc Intervent Radiol. 2012;35(3):588–97. doi:10.1007/s00270-011-0175-1.

    Article  PubMed  Google Scholar 

  20. Kuo WT, Cupp JS. The excimer laser sheath technique for embedded inferior vena cava filter removal. J Vasc Interv Radiol. 2010;21(12):1896–9. doi:10.1016/j.jvir.2010.08.013.

    Article  PubMed  Google Scholar 

  21. • Kuo WT, Odegaard JI, Rosenberg JK, Hofmann LV, Kuo WT, Odegaard JI, et al. Excimer laser-assisted removal of embedded inferior vena cava filters: a single-center prospective study. Circ Cardiovasc Interv. 2013;6(5):560–6. doi:10.1161/circinterventions.113.000665. Important prospective study assessing the use of the new laser-assisted IVC retrieval technique.

    Article  PubMed  Google Scholar 

  22. Saito N, Shimamoto T, Takeda T, Marui A, Kimura T, Ikeda T, et al. Excimer laser–assisted retrieval of Günther Tulip vena cava filters: a pilot study in a canine model. J Vasc Interv Radiol. 2010;21(5):719–24. doi:10.1016/j.jvir.2010.01.028.

    Article  PubMed  Google Scholar 

  23. Asch MR. Initial experience in humans with a new retrievable inferior vena cava filter. Radiology. 2002;225(3):835–44. doi:10.1148/radiol.2252011825.

    Article  PubMed  Google Scholar 

  24. Hagspiel KD, Leung DA, Aladdin M, Spinosa DJ, Matsumoto AH, Angle JF. Difficult retrieval of a recovery IVC filter. J Vasc Interv Radiol. 2004;15(6):645–7. doi:10.1097/01.rvi.0000127887.62434.a8.

    Article  PubMed  Google Scholar 

  25. Turba UC, Glaiberman C, Picus D, Arslan B, Angle JF, Matsumoto AH. Management of severe vena cava filter tilting: experience with bard G-2 filters. J Vasc Interv Radiol. 2008;19(3):449–53. doi:10.1016/j.jvir.2007.11.020.

    Article  PubMed  Google Scholar 

  26. Rubenstein L, Chun AK, Chew M, Binkert CA. Loop-snare technique for difficult inferior vena cava filter retrievals. J Vasc Interv Radiol. 2007;18(10):1315–8. doi:10.1016/j.jvir.2007.07.002.

    Article  PubMed  Google Scholar 

  27. Lynch FC. Balloon-assisted removal of tilted inferior vena cava filters with embedded tips. J Vasc Interv Radiol. 2009;20(9):1210–4. doi:10.1016/j.jvir.2009.06.022.

    Article  PubMed  Google Scholar 

  28. Yamagami T, Kato T, Nishimura T. Successful retrieval of a Gunther tulip vena cava filter with the assistance of a curved sheath introducer. J Vasc Interv Radiol. 2005;16(12):1760–2. doi:10.1097/01.rvi.0000184533.08722.3b.

    Article  PubMed  Google Scholar 

  29. Yallampalli S, Irani Z, Kalva SP. Endovascular removal of a permanent “TrapEase” inferior vena cava filter. Vasc Endovasc Surg. 2013;47(5):379–82. doi:10.1177/1538574413487437.

    Article  Google Scholar 

  30. Stavropoulos SW, Dixon RG, Burke CT, Stavas JM, Shah A, Shlansky-Goldberg RD, et al. Embedded inferior vena cava filter removal: use of endobronchial forceps. J Vasc Interv Radiol. 2008;19(9):1297–301. doi:10.1016/j.jvir.2008.04.012.

    Article  PubMed  Google Scholar 

  31. • Stavropoulos SW, Ge BH, Mondschein JI, Shlansky-Goldberg RD, Sudheendra D, Trerotola SO. Retrieval of tip-embedded inferior vena cava filters by using the endobronchial forceps technique: experience at a single institution. Radiology. 2015;275(3):900–7. doi:10.1148/radiol.14141420. Important study assessing the new endobronchial foreceps-assisted IVC filter retrieval technique.

    Article  PubMed  Google Scholar 

  32. White S, Stavropoulos S. Retrieval of a wall-embedded recovery inferior vena cava filter using rigid bronchoscopy forceps. Semin Interv Radiol. 2007;24(1):015–9. doi:10.1055/s-2007-971191.

    Article  Google Scholar 

  33. Avery A, Stephens M, Redmond K, Harper J. Initial experience using the rigid forceps technique to remove wall-embedded IVC filters. J Med Imaging Radiat Oncol. 2015;59(3):306–11. doi:10.1111/1754-9485.12299.

    Article  PubMed  Google Scholar 

  34. Burke CT, Dixon RG, Stavas JM. Use of rigid bronchoscopic forceps in the difficult retrieval of the Günther Tulip inferior vena cava filter. J Vasc Interv Radiol. 2007;18(10):1319–23. doi:10.1016/j.jvir.2007.06.033.

    Article  PubMed  Google Scholar 

  35. Kuo WT, Odegaard JI, Louie JD, Sze DY, Unver K, Kothary N, et al. 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. 2011;22(6):813–23. doi:10.1016/j.jvir.2011.01.459.

    Article  PubMed  Google Scholar 

  36. Marquess JS, Burke CT, Beecham AH, Dixon RG, Stavas JM, Sag AA, et al. Factors associated with failed retrieval of the Günther Tulip inferior vena cava filter. J Vasc Interv Radiol. 2008;19(9):1321–7. doi:10.1016/j.jvir.2008.06.004.

    Article  PubMed  Google Scholar 

  37. Desjardins B, Kamath SH, Williams D. Fragmentation, embolization, and left ventricular perforation of a recovery filter. J Vasc Interv Radiol. 2010;21(8):1293–6. doi:10.1016/j.jvir.2010.04.019.

    Article  PubMed  Google Scholar 

  38. Joels CS, Sing RF, Heniford BT. Complications of inferior vena cava filters. Am Surg. 2003;69(8):654–9.

    PubMed  Google Scholar 

  39. Nazzal M, Chan E, Nazzal M, Abbas J, Erikson G, Sediqe S, et al. Complications related to inferior vena cava filters: a single-center experience. Ann Vasc Surg. 2010;24(4):480–6. doi:10.1016/j.avsg.2009.07.015.

    Article  PubMed  Google Scholar 

  40. Loehr SP, Hamilton C, Dyer R. Retrieval of entrapped guide wire in an IVC filter facilitated with use of a myocardial biopsy forceps and snare device. J Vasc Interv Radiol. 2001;12(9):1116–8. doi:10.1016/s1051-0443(07)61602-9.

    Article  CAS  PubMed  Google Scholar 

  41. • Abtahian F, Hawkins BM, Ryan DP, Cefalo P, Nasser NJ, MacKay C, et al. Inferior vena cava filter usage, complications, and retrieval rate in cancer patients. Am J Med. 2014;127(11):1111–7. doi:10.1016/j.amjmed.2014.06.025. Recent retrospective study assessing the complication and retrieval rates of IVC filters in a large tertiary referral center.

    Article  PubMed  Google Scholar 

  42. Group PS. 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. 2005;112(3):416–22. doi:10.1161/CIRCULATIONAHA.104.512834.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Dania Daye MD, PhD & T. Gregory Walker MD

Authors
  1. Dania Daye MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Gregory Walker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Gregory Walker MD.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Vascular Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Daye, D., Walker, T.G. Novel and Advanced Techniques for Complex IVC Filter Retrieval. Curr Treat Options Cardio Med 19, 28 (2017). https://doi.org/10.1007/s11936-017-0529-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11936-017-0529-3

Keywords

Search

Navigation