Abstract No. 198 - Endovascular removal of fractured ivc filter fragments: a 5-year prospective study

Abstract

To evaluate the safety and efficacy of IVC filter fragment removal during retrieval of embedded IVC filters. Over a 5-year period, 82 consecutive patients presenting with an embedded IVC filter complicated by fractured fragments were prospectively enrolled into an IRB–approved study. There were 27 men and 55 women (mean: 47 years, range: 19–85). After main filter removal, percutaneous fragment removal was attempted if deemed accessible and intravascular on pre-procedure CT and/or intraprocedure cone-beam CT (DynaCT), and distal pulmonary artery fragments were left alone. Removal of intracardiac fragments was attempted in the same session or later in conjunction with EP cardiology. Rigid forceps were used in the IVC, and cardiopulmonary fragments were approached with snares, angled catheters, curved sheaths, and intravascular ultrasound (IVUS) if needed. All data were captured using REDCap. There were 82 filters (96% placed at OSH): 23 Bard G2/G2X/Eclipse (28.1%), 12 Bard Recovery (14.6%), 3 Bard Meridian (3.7%), 1 Bard Denali (1.2%), 20 Celect (24.4%), 3 Gunther Tulip (3.7%), 2 Option (2.4%), 1 ALN (1.2%), 7 Optease (8.5%), 5 Trapease (6.1%), 2 Simon Nitinol (2.4%), 2 24-Fr Greenfield (2.4%), 1 Titanium Greenfield (1.2%). Mean dwell time was 2183 days, range: 59-9936 days. 185 fragments were identified (83 IVC, 34 PA, 15 cardiac, 2 hepatic vein, 1 renal vein, 1 aorta, 50 extraluminal) and 5(5.7%) embolized during the procedure (3 PA, 1 RA, 1 HV). 87/185 (47%) were deemed amenable to attempted removal: 65 IVC, 11 PA, 8 cardiac, 2 hepatic, 1 aortic. Adjunctive DynaCT was used in 10 and intracardiac IVUS in 2. Removal was successful in 78/87(89.7%) (95%CI:83.3-96.1). Among 9 failures, 4 fragments were embedded in PA, 2 in RA, 2 in RV, 1 in HV. There was 1 major complication (1.1%) (95%CI:0.0-3.3%), cardiac tamponade during attempted RV fragment removal, successfully treated with pericardial drain. The complication rate from attempted cardiac fragment removal was 1/8(12.5%) (95%CI:0.0-34.4%). Percutaneous removal of filter fragments from the IVC and pulmonary arteries is overall safe and effective, but intracardiac fragment removal carries a higher risk of complications.