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IVC Filter Retrieval
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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
IVC Filter Retrieval Podcasts
Listen to leading physicians discuss ivc filter retrieval on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
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
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 https://www.backtable.com/shows/vi
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