Balloon-assisted Removal of Tilted Inferior Vena Cava Filters with Embedded Tips

Abstract

The successful removal of most retrievable inferior vena cava (IVC) filters requires the capture of the filter apex. The severely tilted filter with an apex in contact with the caval wall and covered by an endothelial cap represents a major technical challenge to removal. While a variety of techniques to deal with this problem have been reported, most require complex wire manipulations or the use of rigid endobronchial forceps. This article describes the successful use of a standard angioplasty balloon to free the apex of severely tilted filters with endothelial apical caps. A retrospective review of those patients who presented for removal of their Bard Recovery or G2 IVC filter between June 2005 and August 2008 was performed. Imaging studies and medical records were reviewed for those patients who had their IVC filters removed using the balloon-assisted technique. The presence of filter tilt and movement as well as the outcome of the technique was recorded for each case. Forty-eight Recovery and 209 G2 filters presented for removal. Ten of these 257 filters (3.6%) were found to be severely tilted with filter apex embedded into the wall of the cava. Eight of these filters were successfully removed using the balloon-assisted technique. No complications resulting from the technique occurred. Balloon-assisted removal of severely tilted embedded G2 and Recovery filters is an effective technique that can be performed using tools commonly available and familiar to most interventionists.