Penetration of Bone by Inferior Vena Cava Filters: Safety and Technical Success of Percutaneous Retrieval

PURPOSE

The technical success and safety of percutaneous inferior vena cava filters (IVCF) retrieval when filter elements are penetrating into adjacent bony structures is unknown. Therefore, our purpose was to evaluate the technical success and safety of IVCF retrieval when filter elements are penetrating into adjacent bone.

MATERIALS AND METHODS

Using percutaneous IVCF retrievals from 2008 to 2018 in adult patients, we conducted a multi-institutional, retrospective review of filters found to penetrate lumbar vertebrae by computed tomography scans. Technical success following the retrieval procedure was recorded. Patient records were assessed for complications from retrieval.

RESULTS

13 patients (2 males; 11 females; mean age: 53.2 years (range: 22-71) were included. Hundred percent of the filters were optional (retrievable) filters. Venous thromboembolism (VTE) with a contraindication to anticoagulation (n = 7; 53.8%) and prophylaxis without venous thromboembolism (n = 3; 23.1%) were the 2 most common indications for IVCF placement. Two filters (15.4%) had >15° of tilt relative to the IVC prior to retrieval while no IVCFs had migrated or caused caval thrombosis. One filter (7.7%) was found to have a fractured strut prior to retrieval. Ten patients (76.9%) were either on anticoagulants or antiplatelet medications at the time of retrieval. No patients were on antibiotics and no patients received periprocedural antibiotics. Median dwell time was 116.5 days (range: 49-5395). All 13 IVCFs were successfully retrieved in a single session (technical success: 100%). Standard snare technique was used in 8 cases (61.5%), endobronchial forces were used in 3 cases (23.1%), and wire loop snare technique was used in 2 cases (15.4%). There were no complications in any patient. Percutaneous retrieval of IVCFs with elements that have penetrated into adjacent vertebrae is both safe and technically feasible.

Effect of scheduling inferior vena cava filter removal during the placement encounter on filter removal rate

OBJECTIVE

In the present study, we sought to determine whether early pre-emptive scheduling of inferior vena cava filter (IVCF) removal during the preoperative IVCF placement visit would affect the IVCF removal rate.

METHODS

All electronically documented IVCF placements at a single institution were reviewed from April 2015 to July 2019. The baseline characteristics included age, the clinical indications for IVCF placement, inpatient/outpatient status, and type of IVCF placed. Statistical analysis was performed using the χ² for discrete variables and the two-tailed paired t test for continuous variables.

RESULTS

A total of 599 patients (mean age, 68 years; 273 women and 326 men) had undergone technically successful IVCF placement. During the preoperative consent process for placement, 232 patients had been scheduled for IVCF removal within 3 months after placement. However, 367 patients had not been scheduled for removal at the preoperative consent process. The indications for placement included failure of anticoagulation, a contraindication to anticoagulation (eg, bleeding), preoperative prophylaxis, and others. Of the 232 patients scheduled for IVCF removal during preoperative consent for IVCF placement, 103 (44%) had undergone successful IVCF removal (mean interval from placement, 107 ± 100 days). Of the 367 nonscheduled patients, 89 (24%) had undergone successful IVCF removal (mean time, 184 ± 215 days). We found a significant improvement in the IVCF removal rate between the scheduled and nonscheduled patients (P < .0001). Three patients (all from the scheduled group) had a clot burden within the IVCF, which meant they were inappropriate for removal. These patients were rescheduled and had eventually undergone uncomplicated removal.

CONCLUSIONS

Scheduling IVCF removal during the placement encounter significantly increased the IVCF removal rate. This approach could be a viable option for institutions where clinic time and/or resources are limited or unavailable and for patients who have difficulty traveling for clinical evaluations.