Various Approaches to Open Inferior Vena Cava Filter Removal

Abstract

Delayed inferior vena cava (IVC) filter retrieval may lead to complications of IVC filter placement, including strut migration and caval erosion into adjacent organs. Whereas percutaneous techniques for removal are preferred, in certain cases this is not possible and open retrieval is necessary. We present outcomes of various approaches to six cases of open IVC filter retrieval. We included six patients who underwent open IVC filter retrieval at our institution from 2013 to 2018. Of the six patients, only one patient had a prior retrieval attempt that was unsuccessful. Four patients presented with abdominal pain alone due to erosion into the duodenum. One patient presented with back pain due to strut erosion into the vertebral body. One patient presented with abdominal and back pain due to erosion into the duodenum, aorta, and vertebral body, and one patient presented with chest pain due to strut migration and perforation of the left ventricular wall with development of pericardial tamponade. Five patients underwent computed tomography scans, and the filters were deemed to be irretrievable percutaneously. One patient had an attempted but failed percutaneous attempt. Various approaches were used to remove the filters. All patients underwent either a midline or subcostal incision for exposure of the IVC. In three patients, after the IVC was clamped and the filter was removed, the cavotomy was repaired primarily. In one patient, the IVC was repaired with bovine pericardial patch because it was scarred down and primary repair would have narrowed the lumen. In one patient, without clamping the IVC, the struts were cut at the point that protruded out of the IVC into the adjacent organs and sutured in place on the IVC wall. In one patient, the hook of the IVC filter protruded out of the IVC, and a snare was used to capture the filter while a purse-string suture was placed to repair the venotomy. One patient required sternotomy and retrieval of a strut from the left ventricle with primary repair as well as an open retrieval of the IVC filter, which were performed separately. All patients had resolution of symptoms after removal, with no morbidity or mortality. Whereas open IVC filter retrieval is rarely required, various approaches can be successfully and safely used for retrieval, with low morbidity.