Predictors of inferior vena cava filter retrieval in a population-based Canadian cohort.

1:57 PM Abstract No. 178 - Effectiveness and complications of routine and advanced inferior vena cava filter retrieval techniques

Reporting Standards for Inferior Vena Caval Filter Placement and Patient Follow-up: Supplement for Temporary and Retrievable/Optional Filters

Quality Improvement Guidelines for the Performance of Inferior Vena Cava Filter Placement for the Prevention of Pulmonary Embolism

Inferior Vena Cava Filter Placement and Retrieval Rates among Radiologists and Nonradiologists

Invited Commentary.

Trends in inferior vena cava filter placement and retrieval at a tertiary care institution

Permanent Inferior Vena Cava Filters Offer Greater Expected Patient Utility at Lower Predicted Cost

Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach

Permanent inferior vena cava filters offer greater expected patient utility at lower predicted cost

Retrievable inferior vena cava (IVC) filters were designed to provide temporary protection from pulmonary embolism, sparing patients from long-term complications of permanent filters. However, many retrievable IVC filters are left in place indefinitely. To review the medical records of patients with IVC filters to determine patient demographics and date of and indication for IVC filter placement, as well as complications, follow-up data, date of IVC filter retrieval, and use of anticoagulant therapy. A retrospective review of IVC filter use between August 1, 2003, and February 28, 2011, was conducted at Boston Medical Center, a tertiary referral center with the largest trauma center in New England. In total, 978 patients. Twenty six patients were excluded from the study because of incomplete medical records. Placement of retrievable IVC filter. In total, 952 medical records were included in the analysis. Of 679 retrievable IVC filters that were placed, 58 (8.5%) were successfully removed. Unsuccessful retrieval attempts were made in 13 patients (18.3% of attempts). Seventy-four venous thrombotic events (7.8% of 952 patients included in the study) occurred after IVC filter placement, including 25 pulmonary emboli, all of which occurred with the IVC filter in place. Forty-eight percent of venous thrombotic events were in patients without venous thromboembolism at the time of IVC filter placement, and 89.4% occurred in patients not receiving anticoagulants. Many IVC filters placed after trauma were inserted when the highest bleeding risk had subsided, and anticoagulant therapy may have been appropriate. While many of these filters were placed because of a perceived contraindication to anticoagulants, 237 patients (24.9%) were discharged on a regimen of anticoagulant therapy. Our research suggests that the use of IVC filters for prophylaxis and treatment of venous thrombotic events, combined with a low retrieval rate and inconsistent use of anticoagulant therapy, results in suboptimal outcomes due to high rates of venous thromboembolism.

To the Editor: Retrievable inferior vena cava (IVC) filter placement has been on the rise over the years, but only a small percentage of retrievable IVC filters have been removed, ranging between 10.1% and 38.9%.[12] Laparoscopic retrieval of IVC filter case report was available since 2015,[3] the filter hook in the case report was seen clearly protruding from the anterior wall of the cava, and there was no need for vena cavotomy and reconstruction. In this case, the IVC filter tip was embedded in the posterior wall and cavotomy was required. Very few studies have reported the laparoscopic IVC filter retrieval through vena cavotomy and reconstruction. A 32-year-old woman presented to our hospital with the history of deep venous thrombosis (DVT) in his right lower extremity. Approximately 2 years before, the patient had a retrievable IVC filter (Cook Celect, COOK MEDICAL, USA) placed in a local hospital due to the right lower leg DVT which happened during her pregnancy. Two separate attempts aimed to remove the filter were unsuccessful, abdominal computed tomography showed the filter tilted and struts of the filter penetrating the caval wall appeared to be outside the IVC [Figure 1a]. Considering the patient's young age and long-term filter-associated complications, decision was made to remove the filter by laparoscopic surgery.Figure 1: (a) Abdomen computed tomography showing the filter legs penetrating through the cava, abutting the abdominal aorta (arrow). (b) The vessel loops wrapped around the inferior vena cava above and below the filter. (c) Use of the wire loop and snare technique for the retrieval of the embedded filter.The operation was performed under general anesthesia. The colon and duodenum were mobilized and retracted to the left, and then the IVC was identified. The gonadal vein and the lumbar veins were ligated with Hem-o-lok clips (Teleflex, Wayne, PA, USA). Vascular control was obtained proximal and distal to the filter. The infrarenal IVC is encircled with a tourniquet, the tourniquet passed through a half-inch piece of 20-F drain catheter and secured in place with a Hem-o-lok clip [Figure 1b]. After alerting the anesthesiologist, the two tourniquets were tightly cinched sequentially (distal and proximal); the cavotomy was performed at the apex of the IVC filter to simplify grasp of the filter tip and to collapse the filter legs. A scissor was necessary to separate the filter tip as it was discovered that the filter tip was embedded in the wall of the IVC. Using a loop snare, the filter hook was engaged and the filter was retracted into a filter-removing sheath [Figure 1c]. Cavotomy was closed using the 5-0 running prolene sutures. The tourniquets were released to restore the caval flow. The patient recovered well from the surgery. Although IVC filters reduce risks of pulmonary embolism, there are filter-related complications such as IVC perforation, penetration of adjacent viscera, and filter fracture.[45] Several techniques for retrievals have been described previously,[5] but some filters are still difficult to be retrieved. When endovascular removal is not possible, filters can be removed by the surgical approach, either open or laparoscopic. The open surgery is more invasive. The laparoscopic approach is suitable for patients with the filter tip well outside the IVC and protruding anteriorly.[3] For the filter tip protruding posteriorly, or embedded in the cava wall like in this case, laparoscopic surgery would be challenging. The major risk of the laparoscopic approach is either significant blood loss or CO2 embolism due to IVC tear. In either situation, immediate transition to an open surgery and transfusion is critical. Fortunately, surgery described in this case went well. In conclusion, laparoscopic retrieval of IVC filters is a complex and technically demanding surgery. Careful preoperative preparation, operative experiences, and proficient skills might improve the safety and success rate of operation. Declaration of patient consent The authors certify that they have obtained the patient consent form. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

To evaluate the safety and technical success of inferior vena cava (IVC) filter retrieval in the setting of aorto-iliac arterial strut penetration. IVC filter registries from six large United States IVC filter retrieval practices were retrospectively reviewed to identify patients who underwent IVC filter retrieval in the setting of filter strut penetration into the adjacent aorta or iliac artery. Patient demographics, implant duration, indication for placement, IVC filter type, retrieval technique and technical success, adverse events, and post procedural clinical outcomes were identified. Arterial penetration was determined based on pre-procedure CT imaging in all cases. The IVC filter retrieval technique used was at the discretion of the operating physician. Seventeen patients from six US centers who underwent retrieval of an IVC filter with at least one strut penetrating either the aorta or iliac artery were identified. Retrieval technical success rate was 100% (17/17), without any major adverse events. Post-retrieval follow-up ranging from 10 days to 2 years (mean 4.6 months) was available in 12/17 (71%) patients; no delayed adverse events were encountered. Findings from this series suggest that chronically indwelling IVC filters with aorto-iliac arterial strut penetration may be safely retrieved.

Pulmonary embolus (PE) is a potentially devastating and fatal postoperative complication in morbidly obese patients. This study was undertaken to review the safety and efficacy of retrievable prophylactic inferior vena cava (IVC) filters in high-risk morbidly obese patients undergoing gastric bypass. Patients who underwent gastric bypass surgery and preoperative insertion of retrievable IVC filters had their records reviewed. Indications for IVC filter insertion were: history of deep venous thrombosis (DVT) or PE, long-standing sleep apnea, venous stasis disease, and/or weight > 400 pounds. 24 patients underwent IVC filter placement before gastric bypass surgery. There were 10 women and 14 men with an average age of 50 +/- 6.3 years (range 39 to 59) and average body mass index (BMI) of 57 +/- 7.5 kg/m(2) (range 49 to 74). BMI greater then 50 kg/m(2) was present in 21 of 24 patients (88%). All patients had successful IVC filter placement. IVC filter retrieval postoperatively was performed in 20 of 24 patients (83%) with three left for clinical reasons and one (4%) left due to technical inability to retrieve. There was one complication directly attributable to IVC filter retrieval. There were no deaths. Five patients (21%) developed DVT or PE postoperatively. Follow-up was 16 +/- 7.6 months (range 8 to 33). Prophylactic IVC filter placement and retrieval can be safely undertaken in high-risk gastric bypass patients. We recommend preoperative IVC filter placement in selected patients.

Role of prophylactic temporary inferior vena cava filters placed at the ICU bedside under intravascular ultrasound guidance in patients with multiple trauma

Case report on the non-operative management of a retrievable inferior vena cava filter perforating the duodenum