Extraordinary Cases in Inferior Vena Cava Filter Retrieval

There has been significant growth in the placement of retrievable inferior vena cava (IVC) filters in recent years.[1] Despite the specific design of these devices to be retrievable, most filters are left in place permanently, in many cases beyond their indicated use.[2] Recent studies have focused on the greater number of device-related complications associated with retrievable filters, which appears to be positively associated with filter dwell time.[3] [4] [5] The United States Food and Drug Administration (FDA) recognizes the issues associated with these devices, issuing an alert in 2010 prompting retrieval of these devices once no longer indicated.[6]

The development of advanced retrieval techniques has positively impacted retrieval rates associated with IVC filters, particularly difficult to remove or embedded devices.[7] When used by experienced operators, these techniques are so effective that they essentially remove the “time limit” on filter removal, which can be performed safely regardless of dwell time.[8] Retrieval of embedded devices can be quite complex. In this article, the authors present five patients in whom extraordinary measures were necessary to achieve technical success and optimal outcomes for each patient.

• References

• 1 Duszak Jr R, Parker L, Levin DC, Rao VM. Placement and removal of inferior vena cava filters: national trends in the Medicare population. J Am Coll Radiol 2011; 8 (7) 483-489
• 2 Gaspard SF, Gaspard DJ. Retrievable inferior vena cava filters are rarely removed. Am Surg 2009; 75 (5) 426-428
• 3 Andreoli JM, Lewandowski RJ, Vogelzang RL, Ryu RK. Comparison of complication rates associated with permanent and retrievable inferior vena cava filters: a review of the MAUDE database. J Vasc Interv Radiol 2014; 25 (8) 1181-1185
• 4 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) 1522-1530.e3
• 5 McLoney ED, Krishnasamy VP, Castle JC, Yang X, Guy G. Complications of Celect, Günther tulip, and Greenfield inferior vena cava filters on CT follow-up: a single-institution experience. J Vasc Interv Radiol 2013; 24 (11) 1723-1729
• 6 U.S. Food and Drug Administration. Removing Retrievable Inferior Vena Cava Filters: FDA Safety Communication. Posted May 6, 2014. Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm . Accessed December 8, 2015
• 7 Kuo WT, Cupp JS, Louie JD , et al. Complex retrieval of embedded IVC filters: alternative techniques and histologic tissue analysis. Cardiovasc Intervent Radiol 2012; 35 (3) 588-597
• 8 Desai KR, Lewandowski RJ, Salem R , et al. Retrieval of inferior vena cava filters with prolonged dwell time: a single-center experience in 648 retrieval procedures. JAMA Intern Med 2015; 175 (9) 1572-1574