Abstract No. 654 Fibrin cap disruption using the hangman technique for retrieval of apex embedded conical IVC filters: a highly effective technique even in filters with long dwell times

Abstract

Hangman technique is an advanced retrieval technique described for conical inferior vena cava (IVC) filters with endothelialized or embedded apex. It uses a subapical guide wire loop for disruption of fibrin cap attaching the filter apex to the IVC wall. Although efficient, the literature on this technique is scant. This study aims to demonstrate the efficacy and reproducibility of the Hangman technique for the retrieval of IVC filters with embedded apex, even the ones with long dwell times. Retrospective review of IVC filter retrieval attempts between Jan 2014 and Aug 2017 yielded 319 cases. Hangman technique was used in 29 of these cases. Two filters were suprarenal and the rest were infrarenal. Filter types were Celect Platinum™ (Cook Inc., Bloomington, Indiana) (n = 11), Celect™ (Cook Inc., Bloomington, Indiana) (n = 6), Option™ELITE (Argon Medical Devices, Inc. Athens, Texas) (n = 6), Denali® (Bard Peripheral Vascular, Tempe, Arizona) (n = 2), Gunther Tulip® (Cook Inc., Bloomington, Indiana) (n = 2), Meridian® (Bard Peripheral Vascular, Tempe, Arizona) (n = 1) and ALN (ALN Implants Chirurgicaux, Ghisonaccia, France) (n = 1). Mean dwell time was 658 days (SD 974 days, range 68-4,753 days, N = 27). The technical success rate was 90% (26/29). Seven patients had prior unsuccessful retrieval attempts. There were no procedure related complications. Mean total procedure time was 81.7 min (27-210 min, N = 29). Mean fluoroscopy time was 37.4 min (10.3-96.3 min, N = 11). Amongst three failures, two Celect™ filters were successfully removed using standard loop-snare technique through the struts, and one Denali® filter was left in situ. The Hangman technique is a safe, highly effective and reproducible technique for retrieving conical filters with embedded apices even after prolonged dwell times.