Inferior Vena Cava Filters

Abstract

Venous thromboembolism (VTE) is common, with an incidence of >400 out of 100 000 people in the United States.1 VTE recurrence is also frequent, occurring in 40% of patients,2 with mortality as high as 30%.3 Also, if left untreated, pulmonary embolism (PE) will occur in as many as 40% of all proximal deep vein thrombosis (DVT).4 Although first-line treatment for VTE is anticoagulation, some patients cannot receive this therapy, and others will experience treatment failure. Consequently, inferior vena cava filter (IVCF) use has been steadily rising in the United States and Europe for the past 2 decades.5,6 Article see p 560 Most IVCFs in modern use allow for retrieval once the indication for use has passed. Practically, a variety of devices and techniques with escalating aggressiveness can be used to remove filters, and the Food and Drug Administration recommends that efforts should be made to retrieve these devices as early as possible. When filters are centered in the inferior vena cava and not firmly attached to the caval walls, dedicated filter grasping devices are often all that is required. A problem arises when filter components are embedded into the caval wall. In these cases, more aggressive retrieval techniques need to be used. Existing techniques may include use of endobronchial forceps and, in extreme cases, open surgical removal. Another solution that may be appropriate in cases of caval thrombosis or occlusion is to perform venoplasty and stenting.7 In these cases, the IVCF may be retrieved or restrained between a stent and the caval wall.8 In this issue of Circulation: Cardiovascular Interventions , Kuo et al9 tackle this problem by using a novel technique. They present their prospective experience in 100 consecutive patients in whom laser-assisted removal of embedded IVCF was implemented. Filters …