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• No further contraindication to anticoagulation
• Permanent filter unnecessary
• Low risk of pulmonary embolism (PE)
• Sufficient life expectancy for removal benefits
• Filter can be safely removed
• Prolonged filter implantation is associated with higher filter-related morbidity
• Eliminates risk of filter-associated IVC thrombosis/DVT
• Eliminates risk of filter migration/fragmentation/penetration
• Significant thrombus within/beneath filter
• Lack of venous access site (occluded IJ and/or femoral)
• Severe uncorrectable coagulopathy
• H&P - what type of filter was placed and why; interval history since placement
• Contraindications to contrast
• Any prior imaging: CT, US and filter placement images
• Lower extremity doppler ultrasound to rule out DVT
• Patency of jugular or femoral veins
Two key issues to filter retrieval:
• Engage the filter apex
• Remove filter legs through sheath
Have a large balloon catheter readily available in case of IVC injury/extravasation
Jugular access for most cases.
• Femoral access for OptEase filters.
Place appropriate sheath: 16 and 18 F sheaths often helpful
Perform cavogram - assess for thrombus and filter position
• If significant thrombus is present - consider aborting retrieval and continue anticoagulation
• If no thrombus - introduce the retrieval snare device
• Snare the retrieval hook of the filter
Optimize imaging: magnification and multiple obliquities
• Counterbalance is important - equal amounts of force applied to upward traction and downward sheathing movements
• Using back tension with the snare, advance sheath over the filter to collapse the filter within sheath
• Pull filter out through sheath
If the filter is tilted and the tip cannot be snared, multiple options for more complex retrieval
• Loop snare commonly used
• Endobronchial forceps to disrupt fibrin cap and grasp the apex
After filter is removed - perform cavogram through the sheath to document appearance of the IVC and evaluation for stenosis or extravasation.
• Carefully review imaging to confirm no retained fragments
• Inspect the removed filter
Remove sheath and hemostasis achieved with manual pressure
• Monitor vital signs closely for 1-3 hours following procedure
• IVC filter fracture/migration/embolization requiring foreign body retrieval
• IVC injury spectrum: spasm, pseudoaneurysm, extravasation
• Injury to adjacent structures due to penetrating struts
• IVC thrombosis.
 Desai KR, Pandhi MB, Seedial SM, et al. Retrievable IVC Filters: Comprehensive Review of Device-related Complications and Advanced Retrieval Techniques. Radiographics. 2017;37(4):1236‐1245. doi:10.1148/rg.2017160167
 Laws JL, Lewandowski RJ, Ryu RK, Desai KR. Retrieval of Inferior Vena Cava Filters: Technical Considerations. Semin Intervent Radiol. 2016;33(2):144‐148. doi:10.1055/s-0036-1582119
 Stavropoulos SW, Ge BH, Mondschein JI, et al. Retrieval of tip-embedded inferior vena cava filters by using the endobronchial forceps technique: Experience at a single institution. Radiology. 2015 Jun;275(3):900-7.
 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.
 Kuo WT, Odegaard JI, Louie JD, 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):813‐823. doi:10.1016/j.jvir.2011.01.459
 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):1548‐1556. doi:10.1016/j.jvir.2009.08.024
 BackTable, LLC (Producer). (2017, September 18). Ep 11 – #FilterOUT [Audio podcast]. Retrieved from