3:30 PM, Abstract No. 126 - Is a cavogram necessary after IVC filter retrieval?

Abstract

To evaluate the utility of inferior vena cavography after temporary IVC filter retrieval using routine and complex techniques. 245 patients (250 consecutive encounters) in whom inferior vena cavography was performed before and after IVC filter retrieval were reviewed from a 12-year period ending 3/2014. Retrieval was considered complex if it required forceps or other adjuncts. The cavograms were assessed for abnormalities including stenosis, filling defects, dissection, and extravasation of contrast. Stenosis was measured with electronic calipers and graded by quartiles. Change in stenosis in a given location greater than or equal to one quartile after removal was considered spasm. Of the original 250 encounters, 2 were excluded because they were removed immediately after being placed, 16 due to missing records, and 4 due to extensive baseline caval thrombosis precluding analysis. Dwell time could not be determined for 15 encounters due to missing records. Filling defects and stenosis were significantly more frequent after retrieval, p < 0.05, but they did not change patient management (Table). The only major abnormality after retrieval was extravasation, which occurred only in the complex group and was treated with balloon tamponade and observation. No dissection was observed. There were no cases of 76% or greater stenosis. Dwell time was not correlated with the presence of abnormalities after retrieval (r = 0.002, p = 0.977). Caval stenosis is the primary abnormality found by cavography after IVC filter retrieval. The lack of cavographic abnormalities requiring treatment following routine IVC filter retrieval may justify omitting the post-retrieval cavogram irrespective of dwell time. While uncommon, extravasation requiring treatment may be seen after complex retrieval, thus cavography remains warranted in this setting.