Article
IVC Filter Retrieval
Dr. Chris Beck • Updated Jan 2, 2024
IVC filter retrieval is a minimally invasive procedure used to remove inferior vena cava (IVC) filters that are no longer needed or have caused complications. These filters are typically placed to prevent blood clots from reaching the lungs, but over time, they may need to be removed to reduce the risk of complications such as filter migration, perforation, or thrombosis. Performed by interventional radiologists under image guidance, IVC filter retrieval ensures precise removal, improving patient safety and reducing long-term health risks. This procedure offers an effective solution for individuals who require filter removal after a period of therapeutic use, supporting overall vascular health and well-being.
Table of Contents
Pre IVC Filter Retrieval Prep
IVC Filter Retrieval Steps
Post-Procedure
Pre IVC Filter Retrieval Prep
Indications
• 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
Benefits
• 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
Contraindications
• Significant thrombus within/beneath filter
• Lack of venous access site (occluded IJ and/or femoral)
• Severe uncorrectable coagulopathy
Pre-Procedural Evaluation
• 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
Featured Podcast
Episode # 3 • 17 Jan 2025
The Importance of a Multidisciplinary Filter Retrieval Program
In this episode, guest host Dr. Robert Ryu interviews Dr. Warren Clements and Dr. Premal Trivedi about the current state of IVC filter retrievals, obstacles to increasing retrieval rates, and their experiences with implementing programs to increase IVC filter retrieval rates within their respective healthcare systems.
This podcast is supported by:
IVC Filter Retrieval Steps
Two Key Issues to IVC Filter Retrieval
• Engage the filter apex
• Remove filter legs through sheath
Have a large balloon catheter readily available in case of IVC injury/extravasation
Access Options
• Jugular access for most cases.
• Femoral access for OptEase filters.
Place Sheath
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
Remove IVC Filter
• 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
Cavogram
• 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
Post-Procedure
Post-Operative Care
• Monitor vital signs closely for 1-3 hours following procedure
Potential IVC Filter Retrieval Complications
• 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.
Additional resources
[1] 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
[2] 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
[3] 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.
[4] 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.
[5] 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
[6] 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
[6] BackTable, LLC (Producer). (2017, September 18). Ep 11 – #FilterOUT [Audio podcast]. Retrieved from https://www.backtable.com/shows/vi
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