Cone over Guide Wire Technique for Difficult IVC Filter Retrieval

Abstract

Retrievable inferior vena cava (IVC) filters are placed in patients who are at temporary increased risk for pulmonary embolism, with or without contraindication for anticoagulation, with the expectation of subsequent removal. The failure to retrieve nonpermanent IVC filters is an increasingly encountered dilemma for vascular interventionalists. One of the more common causes of technical failure of retrieval is the presence of tilt in the orientation of the IVC filter, which may result in the retrieval hook abutting the wall of the IVC, preventing contact with the removal system [1]. This issue may be compounded by endothelialization of the filter hook [2]. We describe a nonconventional method for the retrieval of tilted IVC filters in two patients. This method uses a femoral access site that is contralateral to the direction of filter tilt in addition to the right internal jugular vein (IJV) access site. A cone-over-guide wire is then used to retrieve the filter, which has been realigned to the caval axis by the gentle application of tension on the guide wire ends. This technique can be used for filters of both the half-basket and double-basket design, when conventional and other nonconventional techniques fail and may make retrieval difficulties pertaining to filter hook endotheliazliation less relevant.