Inferior vena cava filter removal after 475-day implantation

A Modified Loop Snare Technique for Difficult Retrievals of Inferior Vena Cava Filter and Migrated Coil

The aim of this study was to evaluate the safety and efficacy of a modified loop snare technique for retrieval of difficult inferior vena cava (IVC) filters and migrated coils.A retrospective review of Günther Tulip filter retrievals between January 2014 and February 2017 was performed. A total of 316 IVC filter retrievals were attempted. In 25 cases, the standard technique had failed and our modified loop snare technique was subsequently attempted in 21 of these patients.The retrievals were successful in 20 cases (mean dwell time, 42.6 days, range, 14-102 days). The dwell time of the one failure was 46 days. The retrieval rate increased from 92.1% with the standard technique to 98.4% with the combination of the standard and modified loop snare technique. Unsuccessful retrieval was due to migration and endothelialization of the filter. This technique can also be used to remove migrated coils which cannot be captured by standard techniques. There were no complications from the retrievals.Tilt and endothelialization of filters are the main factors resulting in unsuccessful retrievals with the standard technique. In the present study, we describe an alternative technique for difficult IVC filter retrievals, which can also be used to capture migrated coils and occluders in the aorta and heart.

Optional Vena Cava Filters: What, Why, and When

Optional vena cava filters can used to provide either short-term or permanent protection from pulmonary embolism. These devices have recently become available for clinical use in the United States. However, there remains a paucity of data about these devices and their outcomes. This article reviews current and future devices, the rationale behind non-permanent caval filtration, and the generally accepted guidelines for their clinical application.

Improving retrieval rates for retrievable inferior vena cava filters

The introduction of retrievable inferior vena cava (IVC) filters was an important step in the evolution of deep vein thrombosis/pulmonary embolism management. Their removability makes them preferred to permanent filters in many cases. IVC filter retrieval often occurs at a suboptimal rate, leading to complications associated with long-term placement. Improving retrievability includes solutions for patients being lost to follow-up, filter malpositioning, need arising for permanent IVC filtration, filtration requiring longer than the filter's window of retrievability, and filter compromise by the presence of a large trapped clot. This review explores these strategies for retrieval in detail in hopes of improving IVC filter retrieval rates.

Optional vena cava filter with disengaging centering struts: retrieval in an animal model

An optional inferior vena cava (IVC) filter prototype was evaluated for safety and long-term retrievability as an initial feasibility study in an animal model. This filter has four centering struts that have the ability to disengage from the filtering cone portion, allowing the legs to slide out of endothelial growth. Retrieval of six filters in three animals was successful up to 27 weeks. There was no substantial filter tilt, migration, or IVC damage. In conclusion, this filter design may help overcome some of the shortcomings in currently approved optional IVC filters, including long-term retrieval difficulties, tilting, or migration.

Use of Rigid Bronchoscopic Forceps in the Difficult Retrieval of the Günther Tulip Inferior Vena Cava Filter

Retrievable inferior vena cava (IVC) filters may, over time, become incorporated into the wall of the IVC, making subsequent removal difficult. The authors present a case in which a Günther Tulip filter was placed prophylactically before gastric bypass surgery. The retrieval hook of the filter became incorporated into the wall of the IVC, preventing the filter from being snared. Eventually, the filter was freed from the wall of the IVC and successfully removed by using rigid bronchoscopy forceps; however, the filter was damaged in the process.

Angioscopy for experimental evaluation of optional IVC filters

PURPOSE

To demonstrate the feasibility of direct angioscopic visualization of an optional inferior vena cava (IVC) filter in situ and during retrieval.

MATERIALS AND METHODS

Angioscopy was used for direct visualization of optional IVC filters in six sheep. Cavograms were obtained before the filters were retrieved. After successful filter retrieval, segmental IVC perfusion was performed to evaluate filter retrieval-related damage to the IVC wall. Therefore, all branch vessels were ligated before the IVC segment was flushed with normal saline solution until it was fully distended. Then, the inflow was terminated and the IVC segment observed for deflation. Subsequently, the IVC was harvested en bloc, dissected, and inspected macroscopically.

RESULTS

The visibility of IVC filters at angioscopy was excellent. During the retrieval procedure, filter collapse and retraction into the sheath were clearly demonstrated. Angioscopy provided additional information to that obtained with cavography, demonstrating adherent material in three filters. Three filters in place for more than 2 months could not be retrieved because the filter legs were incorporated into the IVC wall. After filter retrieval, there was no perforation at segmental IVC perfusion. At macroscopic inspection of the IVC lumen, a small piece of detached endothelium was found in one animal.

CONCLUSION

Angioscopy enabled the direct evaluation of optional IVC filters in situ and during retrieval. Compared with cavography, angioscopy provided additional information about the filter in situ and the retrieval procedure. Future applications of this technique could include studies of filter migration, compression, and clot-trapping efficacy.

Retrievable and Permanent Inferior Vena Cava Filters: Selected Considerations

The use of inferior vena cava (IVC) filters is increasing rapidly, and the recent availability of retrievable IVC filters is certain to accelerate this process. Unfortunately, because the risks and benefits of these devices have not been adequately studied, several important issues remain. Limitations of the quality of the data in the available literature make it virtually impossible to accurately quantify the specific rates of complications with various devices. Although many clinicians believe that the use of an IVC filter obviates anticoagulation, new data support the need for long-term anticoagulation in such patients. The recent introduction of retrievable IVC filters may eliminate the need for long-term anticoagulation if the filter can be removed, but further data are needed to ascertain the place of these devices in modern therapy. The increasing use of these devices increases the need for clinicians to be aware of the potential limitations and risks of IVC filters.

Günther Tulip Filter Retrievability Multicenter Study Including CT Follow-up: Final Report

PURPOSE

To evaluate the safety and effectiveness of retrieval of the Günther Tulip inferior vena cava (IVC) filter.

MATERIALS AND METHODS

This was a nonrandomized, single-armed, multicenter prospective investigation. Patients at temporary high risk for pulmonary embolism (PE) or deep vein thrombosis (DVT) who did not require a permanent filter were eligible. Forty-one patients received 42 Günther Tulip filters: 22 men and 19 women with a mean age of 47.7 years. Indications for filter placement included prophylaxis, PE, and DVT. Three months after filter retrieval, contrast agent-enhanced computed tomography of the abdomen, jugular vein ultrasonography, and clinical follow-up were performed.

RESULTS

The filter retrieval rate was 57% (23 of 41). Günther Tulip filters were removed at a mean of 11.1 days (range, 2-14 d). The technical and clinical success rates for filter retrieval were both 100%. One placement complication and two protocol deviations occurred. These patients were excluded in terms of retrieval-related outcomes. One case of PE occurred with a filter in place, and one filter migrated to the heart. There were no acute complications caused by filter retrieval. At 3-month follow-up, there was no recurrent PE, DVT, jugular vein occlusion, or IVC stenosis or occlusion.

CONCLUSION

In this multicenter study, retrieval of the Günther Tulip filter was safe and without recurrent thromboembolic events or evidence of IVC or jugular vein damage at 3-month follow-up.

Vena cava filters in spinal cord injuries: evolving technology

BACKGROUND

Asymptomatic deep venous thrombosis (DVT) has been reported in 60% to 100% of persons with spinal cord injury (SCI). Several guidelines have been published detailing recommended venous thromboembolism (VTE) prophylaxis after acute SCI. Low-molecular-weight heparin, intermittent pneumatic compression (IPC) devices, and/or graduated compression stockings are recommended. Vena cava filters (VCFs) are recommended for secondary prophylaxis in certain situations.

OBJECTIVE

To clarify the use of vena cava filters in patients with SCI.

METHODS

Literature review.

RESULTS

Prophylactic use of vena cava filters has expanded in trauma patients, including individuals with SCI. Filter placement effectively prevents pulmonary emboli and has a low complication rate. Indications include pulmonary embolus while on anticoagulant therapy, presence of pulmonary embolus and contraindication for anticoagulation, and documented free-floating ileofemoral thrombus. VCFs should be considered in patients with complete motor paralysis caused by lesions in the high cervical cord (C2 and C3), with poor cardiopulmonary reserve, or with thrombus in the inferior vena cava despite anticoagulant prophylaxis. Three optional retrievable filters that are approved for use are discussed.

CONCLUSION

Retrievable VCFs are a safe, feasible option for secondary prophylaxis of VTE in patients with SCI. Objective criteria for temporary and permanent placement need to be defined.