Abstract
Purpose To evaluate the safety and efficacy of the excimer laser sheath technique for removing embedded IVC filters. Materials and Methods Over a 3-year period, 100 consecutive patients were prospectively enrolled into an IRB-approved study. There were 42 men and 58 women (mean: 46 years, range 18-76). Indications for retrieval included symptomatic acute IVC thrombosis, chronic IVC occlusion, and/or pain from retroperitoneal or bowel penetration. Retrieval was also performed to prevent risks from prolonged implantation and potentially to eliminate need for lifelong anticoagulation. After standard methods failed, treatment escalation was attempted with a laser sheath for photothermal tissue ablation, powered by a 308 nm XeCl excimer laser (CVX-300, Spectranetics). Applied forces were recorded using a digital tension meter before and after laser activation. All retrieved specimens were sent for histologic analysis. Results Laser-assisted retrieval was successful in 98.0% (95%CI:93.0-99.8%) with mean implantation of 855 days, range: 37-6663 days ( > 18 years), among the following: Gunther Tulip (n = 34), Celect (n = 12), Option (n = 17), OPTEASE (n = 20, 1 failure), TRAPEASE (n = 6, 1 failure), Simon-Nitinol (n = 1), 12-Fr SS Greenfield (n = 4), Titanium Greenfield (n = 6). Average force during failed standard retrievals was 7.2 lbs versus 4.6 lbs during laser-assisted retrievals (p Conclusion Excimer laser tissue ablation is effective for removing embedded IVC filters refractory to standard retrieval and high force. With appropriate expertise, this technique can safely be used to help prevent and alleviate filter-related morbidity.
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