To evaluate the safety and effectiveness of the excimer laser sheath technique for removing embedded IVC filters refractory to standard retrieval methods. In a 12-month period, 21 consecutive patients undergoing attempted filter retrieval with a laser-assisted sheath technique were prospectively enrolled into an IRB-approved study registry. There were 8 men and 13 women (mean age 48 years, range 20–76). 14/21 (67%) of the patients were referred from an outside hospital. Retrieval indications included symptoms from filter-related acute caval thrombosis ± acute PE, chronic IVC occlusion, and bowel penetration. Retrieval was also performed to remove risks from prolonged implantation and to potentially eliminate need for lifelong anticoagulation. After failure of standard methods, controlled photothermal tissue ablation with a 12-, 14-, or 16-Fr laser sheath and CVX-300 Spectranetics laser system was performed alone or with adjunctive maneuvers. All patients were evaluated with immediate cavography, and retrieved specimens were sent for histologic analysis. Additional follow-up was performed at outpatient clinic visits. Laser-assisted retrieval was successful in 20/21 (95%) (95% CI: 76%,100%) as follows: 10 Günther-Tulip (mean 365 days, range 127–882), 4 Celect (mean 387 days, range 332–440), 1 Option (100 days), 3 Optease (mean 336 days, range 71–749, 1 failed: 188 days), 1 Trapease (187 days), 2 Greenfield (1 titanium, 1 12-Fr stainless steel: mean 12.8 years, range 7.2–18.3). There was 1 major complication (acute thrombus, treated with thrombolysis) (5%) (95% CI: 0%, 24%), and 1 minor complication (scant extravasation, self-limited) (5%) (95% CI: 0%, 24%). There were no adverse events at follow-up (mean 111 days, range 7–267) (0 events in 2317 person-days) (95% CI: 0,0.0016 events/person-day). Photothermal tissue ablation was histologically confirmed in 19/21 (90%) (95% CI: 70%, 99%), and all ablation margins consisted mainly of neointimal hyperplasia and fibrosis. Photothermal ablation with the laser-assisted sheath technique appears to be a safe and effective tool for retrieving a variety of embedded IVC filters, including permanent types, with dwell times ranging from months to > 18 years.