Retrievable Inferior Vena Cava Filters Research Articles

Kissing Sheath Technique for Permanent Inferior Vena Cava

In patients where anticoagulation therapy is contraindicated, Inferior Vena Cava (IVC) filters are used as an option to prevent Pulmonary Embolism (PE). There are many classifications of Vena Cava filters the two main groups are; those intended for permanent implantation and the other temporary (which are to be retrieved at a later date). Permanent IVC filters are not designed to be removed, unless unexpected clinical circumstances arise. We describe a complex case of retrieval of a permanent IVC filter, though well documented; it is the first of its kind to be recorded in the Caribbean.

Retrievable Inferior Vena Cava Filters: A Tertiary Centre Perspective and Quality Assurance Study

PurposeTo conduct a retrospective review and quality assurance study of inferior vena cava (IVC) filter retrieval over a two-year period at a tertiary care centre. MethodsPatients who underwent IVC filter placement or retrieval over a two-year period were identified. Medical records were reviewed for patient characteristics, filter indication, time to filter retrieval, and complications. ResultsIVC filters were placed in 229 patients between January 1, 2015 and December 31, 2016. 113 retrievals were attempted and 101 filters were successfully retrieved (89.4%). Median time to first retrieval attempt was 48 days (range of 5–728). Seventy-one patients died in the interval after filter insertion before a retrieval attempt at a median time of 27 days (range of 3–430). In 17 patients, retrieval was complicated by or delayed because of penetration of IVC wall (n = 6), large thrombus burden trapped by filter (n = 5), filter tilt or migration (n = 3), and unclear reasons (n = 3). Time-to-first unsuccessful retrieval attempt was 141 days (median). Of all filters placed, 55.9% were never retrieved. Excluding deceased patients with in-situ filters (n = 71) and unsuccessful retrievals left in-situ as permanent filters (n = 5), there remains 52 patients (33%), with a median filter in-situ time of 488 days. ConclusionOur study indicates that as many as 33% of patients may have been lost to follow-up of their in-situ IVC filter. Considering widespread reports of long-term complications and the recent safety alert issued by Health Canada, it is evident that a unified strategy is needed to track patients post filter insertion.

A Modified Loop Snare Technique for Difficult Retrievals of Inferior Vena Cava Filter and Migrated Coil.

The aim of this study was to evaluate the safety and efficacy of a modified loop snare technique for retrieval of difficult inferior vena cava (IVC) filters and migrated coils.A retrospective review of Günther Tulip filter retrievals between January 2014 and February 2017 was performed. A total of 316 IVC filter retrievals were attempted. In 25 cases, the standard technique had failed and our modified loop snare technique was subsequently attempted in 21 of these patients.The retrievals were successful in 20 cases (mean dwell time, 42.6 days, range, 14-102 days). The dwell time of the one failure was 46 days. The retrieval rate increased from 92.1% with the standard technique to 98.4% with the combination of the standard and modified loop snare technique. Unsuccessful retrieval was due to migration and endothelialization of the filter. This technique can also be used to remove migrated coils which cannot be captured by standard techniques. There were no complications from the retrievals.Tilt and endothelialization of filters are the main factors resulting in unsuccessful retrievals with the standard technique. In the present study, we describe an alternative technique for difficult IVC filter retrievals, which can also be used to capture migrated coils and occluders in the aorta and heart.

Multi loop snare technique for difficult inferior vena cava filter retrievals

IntroductionUse of optional vena cava filters has steadily increased. In the majority of cases removal is successful using standard techniques. In cases of tilting and migration of the filter however, more advanced techniques are necessary. The “loop-snare” technique has been described for such cases. Difficulties arise when the loop starts to slip around the legs and arms of the filter.New techniqueWe present an improved loop-snare technique which allows to retrieve IVC filters when the simple loop-snare technique fails. We used additional loops, in one case one additional loop in another case two additional loops around the filter tip which allowed successful retrieval. The additional loops were created with a reversed shaped catheter. All guidewires were then engaged with a snare and pulled into a large sheath. The additional loops stabilize the tip and the filter can be pulled into the sheath.ConclusionThe “multiple-loop-snare” technique is a refinement of the previously described “single loop-snare” technique and can be used when one loop fails.

Factors Affecting Inferior Vena Cava Filter Retrieval: A Review.

Over the last 2 decades, there has been an exponential rise in placement of retrievable inferior vena cava (IVC) filters, while the retrieval rate has remained steadily low. Approaches to increasing filter retrieval rates have been extensively studied. This review presents an up-to-date review of reported data-driven variables that affect retrieval rates of IVC filters, with a focus on clinical, technical, and process factors.

Endobronchial forceps-assisted complex retrieval of inferior vena cava filters

ObjectiveThe objective of this study was to assess the safety, feasibility, and effectiveness of endobronchial forceps-assisted retrieval of inferior vena cava (IVC) filters when standard retrieval techniques fail. MethodsAn Institutional Review Board-approved single-center retrospective review during a 6-year period identified 60 consecutive patients (23 men and 37 women; mean age, 49.3 years; range, 19-77 years) in whom rigid endobronchial forceps were required for IVC filter retrieval after standard techniques failed. Factors affecting retrieval success, including an embedded or tilted filter, overall dwell time, filter fracture, and caval penetration, were recorded, as were success rates, procedural details, and complications. ResultsMean dwell time between filter placement and removal was 565 days (range, 15-7366 days). Various IVC filters were encountered: 33 Option (Argon Medical, Frisco, Tex), 8 Celect (Cook Medical, Bloomington, Ind), 9 Günther Tulip (Cook Medical), 4 G2 and 3 Eclipse (Bard, Murray Hill, NJ), 2 OptEase (Cordis, Bridgewater, NJ), and 1 Simon Nitinol (Bard). Imaging before retrieval showed grade 1 (3/60), grade 2 (44/60), and grade 3 (13/60) filter interaction with IVC wall. The degree of secondary tilt as assessed on images acquired before attempted retrieval was <10 degrees (n = 22; 36.7%), 10 to 20 degrees (n = 26; 43.3%), and >20 degrees (n = 12; 20%), with an average tilt of 13.8 degrees (range, 0-48.9 degrees). Of the 60 filters, 58 were retrieved successfully (96.7%). Two of these required a second attempt (one because of migration into the right atrium and the other because of extreme discomfort of the patient requiring subsequent general anesthesia). Five of 60 procedures were forceps-assisted loop snare retrievals in which the forceps were used to dissect the embedded hook free from surrounding hyperplastic caval venous endothelium. Mean fluoroscopy retrieval time was 33.2 minutes (range, 10-76.9 minutes). Intraprocedural inconsequential filter fracture was observed in 10 patients. There were four complications: one retroperitoneal hemorrhage, one IVC dissection flap, and two filter fractures with subsequent migration of filter components to the right side of the heart and to the right pulmonary artery. The first two complications required hospital admission and conservative management; in the last two, the fractured and migrated filter limbs were retrieved successfully using a snare device. ConclusionsRigid endobronchial forceps can be safely and reliably used to remove embedded, fractured, or tilted retrievable IVC filters from patients in whom standard retrieval techniques are unsuccessful. There is a high success rate and minimal complications. We propose that the degree of filter tilt, caval penetration, and filter fracture are predictive of the need for the use of forceps as a first-line retrieval technique.

Persistently low inferior vena cava filter retrieval rates in a population-based cohort

BackgroundPractice patterns associated with inferior vena cava (IVC) filter placement have seen considerable variation in the last decade. We used a statewide administrative database to examine trends in IVC filter placement and retrieval in the general population. MethodsWe reviewed Florida state inpatient and ambulatory surgery databases from 2004 to 2014. International Classification of Diseases, Ninth Revision diagnosis and procedure codes and Current Procedural Terminology codes were searched for patients undergoing inpatient or outpatient IVC filter placement, and each patient was longitudinally tracked to the time of inpatient or outpatient filter retrieval. For inpatient filter placements, associated diagnoses were reviewed to identify indications for placement. Univariate and multivariate logistic regression models were constructed to identify factors associated with improved retrieval rates. ResultsDuring the 11-year period, 131,791 IVC filter placements were identified, with a 50% increase from 2004 to 2010 and a 24% decline from 2010 to 2014. Median age at filter placement was 71 years (interquartile range, 57-81 years). Mean follow-up after filter placement was 17.3 ± 25.5 months. Only 8637 filters (6.6%) were retrieved. The annual retrieval rate trended upward, from 3.4% in 2004 to 8.5% in 2013 (P < .001). Median filter dwell time was 96.5 days (interquartile range, 44-178 days). Diagnoses associated with filter placement included venous thromboembolism (75.9%), trauma (35.0%), hemorrhage (29.9%), malignant disease (29.4%), and stroke (5.1%). Retrieval rates were highest in younger patients (34.0% in patients younger than 20 years) and lowest in Medicare patients (2.5%). In a multivariate logistic regression model, Medicare was associated with decreased retrieval rates (odds ratio, 0.33; 95% confidence interval, 0.31-0.35; P < .001) after adjusting for age and associated diagnoses. Weaker risk factors included increased age, white race, and diagnoses of deep venous thrombosis, pulmonary embolism, and malignant disease. A trauma diagnosis was associated with improved retrieval. To further investigate the Medicare effect, a propensity score-matched model was created to better account for confounding effects. In this model, Medicare persisted as a risk factor for decreased filter retrieval (odds ratio, 0.43; 95% confidence interval, 0.40-0.46; P < .001). ConclusionsIVC filter placements, after a substantial increase between 2004 and 2010, have been declining since 2010. Retrieval rates in the general population are steadily improving but continue to lag behind those described in center-specific literature. Increased age and Medicare as the primary payer are the strongest risk factors for lack of filter retrieval. Widespread improvements on a national scale are needed to improve the appropriateness of filter placements and to enhance filter retrieval rates.

Excimer laser assisted complex inferior vena cava filter retrieval: a single institution's experience over 6 years

To investigate inferior vena cava (IVC) filter retrievals and the use of the excimer laser sheath to assist in complex cases. Retrospective analysis was undertaken of 181 attempted filter retrievals over a 6 year period. Pre- and perioperative imaging was analysed from both standard retrieval and complex retrieval techniques. One hundred and eighty-one IVC filter retrievals were attempted: 130 (72%) standard retrievals were successful and 51 (28%) failed due to device endothelialisation. Forty (23%) cases then had subsequent successful complex retrieval under general anaesthetic. Eighteen (45%) cases were removed with the sling technique and 22 (55%) cases using the excimer laser dissection technique. Where preoperative venography/computed tomography (CT) demonstrated embedding of the filter feet versus filter apex, this was predictive of requiring dissection techniques versus sling technique (13/18 patients; p<0.05 chi-squared test). The difference in device indwelling time was statistically significant between the successful standard retrieval group (134 days) versus patients who failed standard retrieval and required complex techniques (243 days; p=0.00018). Standard retrieval techniques failed in 28% of cases. This correlated with devices that were indwelling for longer. When imaging demonstrated filter-feet endothelisation/perforation, this was predictive of requiring dissection techniques with the excimer laser.

Usefulness of a Computerized Reminder System to Improve Inferior Vena Cava Filter Retrieval and Complications

Inferior vena cava filters (IVCF) are associated with complications which may be due to delayed retrieval. Initiation of an automated reminder system may improve retrieval rates and reduce complications. A computerized reminder system, which provides interactive email reminders after implantation while collecting IVCF use data, was implemented. IVCF retrieval was compared before ("reminder not provided" group) and after ("reminder provided" group) implementation. Data regarding implantation, retrieval, and complications were collected. The primary efficacy outcome was retrieval rate, and the primary safety outcome was indwelling complication rate. Secondary outcomes were time to retrieval and a composite adverse outcome defined as IVCF thrombosis, deep venous thrombosis (DVT), pulmonary embolism, and death. A total of 1,070 IVCF insertions were included, 715 in the "reminder not provided" group and 355 in the "reminder provided" group. Patient age (61 vs 64 years, p = 0.95) and gender (42% vs 40% female, p = 0.55) were similar in the "reminder not provided" and "reminder provided" groups, respectively. In the "reminder provided" group, the retrieval rate was higher (148/297 [49.8%] vs 223/715 [31.2%], p = 0.0001), the indwelling complication rate was lower (30/319 [9.4%] vs 115/715 [16.1%], p = 0.005), and the time to retrieval was shorter (112 days vs 146 days, p = 0.02). The composite adverse outcome occurred less frequently in the "reminder provided" group: (85/355 [23.9%] vs 297/715 [41.5%], p = 0.0001). The system was associated with increased odds of IVCF retrieval (odds ratio 2.56; 95% confidence interval: 1.82 to 3.59; p <0.0001) and reduced odds of the composite adverse outcome (odds ratio 0.72; 95% confidence interval: 0.60 to 0.80; p <0.0001). In conclusion, implementing a computerized email reminder system was associated with higher IVCF retrieval rates, fewer indwelling complications, and shorter dwell times.

Statewide Inferior Vena Cava Filter Placement, Complications, and Retrievals: Epidemiology and Recent Trends

Background:Public awareness of inferior vena cava (IVC) filter-related controversies has been elevated by the Food and Drug Administration (FDA) safety communication in 2010.Objectives:To examine population level trends in IVC filter utilization, complications, retrieval rates, and subsequent pulmon

Analyzing the impact of systems-based hematologist in the healthcare system at an academic medical center.

Over the next decade, there is a predicted shortage of nonmalignant hematologist to maintain the workforce in the United States. To address this, the American Society of Hematology described the creation of the healthcare systems-based hematologist (SBH). The role of SBH has the potential to provide high-value, cost-conscious care to the healthcare system. In 2011, an Anticoagulation and Bleeding Management Medical Directorship position for a SBH was created at our healthcare system. We described our 6-year experience as SBH at a 750-bed tertiary academic medical center to improve clinical outcomes while reducing costs. Via four different initiatives, we were able to provide high-value, cost-conscious care as SBH by reducing cost of heparin-induced thrombocytopenia management, optimizing blood product utilization using goal-directed algorithms, reducing inappropriate thrombophilia testing and improving inferior vena cava filter retrieval rates. To ensure continuing success as a SBH, business plans need to include education, enforcement, monitoring, feedback, validation of safety and outcomes and a shared vision among leadership.

An analysis of factors associated with increased fluoroscopy time or the need for complex techniques at IVC filter retrieval.

To evaluate factors associated with increased fluoroscopy time or the need for complex techniques at IVC filter retrieval. This is a single-institution retrospective cohort study of 187 consecutive patients who underwent IVC filter retrieval. An analysis was performed on associations of patient factors with increased fluoroscopy time and/or the need for complex retrieval techniques. A complex retrieval was defined as one requiring more than standard sheath and snare technique. Access vein during filter placement was not associated with filter tilt at placement or removal (p = 0.61 and 0.48). Neither the direction of the hook nor its relationship to the tilt was associated with the need for complex retrieval or increased retrieval fluoroscopy time (p = 0.25, 0.23, p = 0.18, 0.23). Tilt angle at placement correlated with hook apposition at time of removal (p = 0.01). Hook apposition was associated with complex retrieval and increased fluoroscopy time (p < 0.01). Larger tilt angle at placement was not associated with complex retrieval (p = 0.22), but a larger angle at removal was (p < 0.01). Longer dwell time correlated with the need for complex retrieval (p = 0.02). Filter type, sex, and age were not associated with complex retrievals (p = 0.58, p = 0.90, p = 0.99). Contrary to previous hypotheses and studies, access vein for filter placement did not affect filter tilting, and direction of filter hook-tilt relationship did not affect retrieval fluoroscopy time or the need for complex retrieval techniques. Increased filter placement angle was associated with a larger angle at removal and hook-wall apposition, both of which were associated with complex retrievals. • Filter hook orientation did not correlate with retrieval complexity. • Filter insertion vein did not correlate with filter tilt. • Filter tilt and hook apposition to the caval wall at the time of retrieval correlated with retrieval procedure complexity.

Institutional protocols can improve IVC filter retrieval rates

Institutional protocols can improve IVC filter retrieval rates

An Informatics Approach to Facilitate Clinical Management of Patients With Retrievable Inferior Vena Cava Filters.

Long indwelling times for inferior vena cava (IVC) filters that are used to prevent venous thromboembolism can result in complications. To improve care for patients receiving retrievable IVC filters, we developed and evaluated an informatics-based initiative to facilitate patient tracking, clinical decision-making, and care coordination. A semiautomated filter-tracking application was custom-built to query our radiology information system to extract and transfer key data elements related to IVC filter insertion procedures into a database. A web-based interface displayed key information and facilitated communication between the interventional radiology clinical team and referring physicians. A set of filter management options was provided depending on each patient's clinical condition. The system was launched in April 2016. Using retrospective observational cohort methods, we compared filter retrieval rates during a test period from July through December 2016 with a control period of the same 6 months in 2015. System development required approximately 100 hours of development time. Two hundred ninety-three IVC filter placements and 83 filter retrievals were tracked during the study periods. The overall filter retrieval rate was 23% in the control period and 34% in the test period. Mean times from filter placement to retrieval in the control and test periods were not significantly different (88.9 and 102.7 days, respectively; p = 0.32). A semiautomated approach to tracking patients with IVC filters can facilitate care coordination and clinical decision-making for a device with known potential complications. Similar applications designed to improve provider communication and documentation of filter management plans, including appropriateness for retrieval, can be replicated.

National Trends in Inferior Vena Cava Filter Placement and Retrieval Procedures in the Medicare Population Over Two Decades

PurposeTo assess trends in inferior vena cava (IVC) filter placement and retrieval procedures in Medicare beneficiaries over the last two decades. MethodsUsing Physician/Supplier Procedure Summary Master Files from 1994 through 2015, we calculated utilization rates for IVC filter placement and retrieval procedures in Medicare fee-for-service beneficiaries. Services were stratified by provider specialty group and site of service. ResultsIVC filter placement rates increased from 1994 to 2008 (from 65.0 to 202.1 per 100,000 beneficiaries, compound annual growth rate [CAGR] +8.4%) and then decreased to 128.9 by 2015 (CAGR −6.2%). This decrease was observed across all specialty groups and sites of service. From 1994 to 2015, placement procedure market share increased for radiologists (from 45.1% to 62.7%) and cardiologists (from 2.5% to 6.7%) but decreased for surgeons (from 46.6% to 27.9%). Overall, procedures shifted slightly from the inpatient (from 94.5% to 86.5% of all procedures) to outpatient hospital (from 4.9% to 14.9%) settings. Between 2012 and 2015, retrieval rates increased from 12.0 to 17.7 (CAGR +13.9%). Retrievals as a percentage of placement procedures were similar across specialties in 2015 (range 13.0%-13.8%). ConclusionDespite prior dramatic growth, the utilization of IVC filters in Medicare beneficiaries markedly declined over the last decade, likely relating to evolving views regarding efficacy and long-term safety. This decline was accompanied by several filter-related market shifts, including increasing placement by radiologists and cardiologists, increasing outpatient placement procedures, and increasing retrieval rates.

How Effective is a Departmental Registry Follow-up form for Improving Retrieval of Inferior Vena Cava Filters? A Single-center Experience

Purpose: This study evaluated the impact of a departmental registry follow-up form on the retrieval rate of retrievable inferior vena cava (IVC) filters. Materials and Methods: We performed a case–controlled retrospective study of all patients who had received such filters 2 years before and after the follow-up registry was implemented at the study center in June 2015. Patients were analyzed based on age, gender, indication, type of filter, date and location of filter insertion, date of retrieval, dwelling time, and previous attempts at retrieval. The two groups were compared in terms of filter type, rate of retrieval, and dwelling time, before and after the registry was implemented. Results: Between June 2013 and May 2017, 307 filters were inserted in 183 males and 124 females. Of these filters, 296 (96.42%) were placed below the renal veins and 11 (3.58%) were placed suprarenally. A total of 148 (48.21%) filters were inserted before implementing the follow-up form and 159 (51.79%) were inserted afterward. The retrieval rate was 35.81% before implementation of the registry form and 38.36% afterward. The mean dwelling time of retrieved filters prior to implementation was 32 days and 48 days during the 2 years after implementation, respectively. Filter retrieval was successful in 110 patients from the first attempt (96.49%) and four patients required more than one attempt (3.51%). Conclusion: The departmental vena cava filters' registry resulted in minimal improvement of retrievability rates. Younger age was associated with increased likelihood of retrieval. These data suggest that additional measures are required to further enhance retrieval rates.

Vena Cava Filter Retrieval with Aorto-Iliac Arterial Strut Penetration.

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.

Retrievable inferior vena cava filter utilization in obstetric patients

Objectives: The objective of this study is to evaluate patterns of use and outcomes of retrievable inferior vena cava filters (rIVCF) in obstetric patients.Methods: A single center review of consecutive patients who underwent rIVCF placement during pregnancy/postpartum in 2005–2016. A pooled analysis of the relevant cases in the English literature was conducted.Results: The current cohort comprised 24 women, median age 27 [interquartile range 24–30] years. Among 10 filters placed during pregnancy, the most common indication (n = 4) was the need to withhold anticoagulation therapy before delivery, in the presence of acute thrombosis. In the postpartum period, most filters (64%, 9/14) were an adjunct to catheter-directed thrombolytic therapy. Inferior vena cava filters (IVCF)-related complications occurred in seven (29.2%). Retrieval was attempted in 21 patients (87.5%), and was technically successful in 19 (90.5%), for an overall removal rate of 79.1%. Pooled analysis of the literature (n = 98) showed comparable rates for filter removal and complications (81.6%, p = .78 and 24.2%, p = .60, respectively). Suprarenal placement (p = .12) and elective cesarean section (p = .19) did not reduce overall complication and retrieval rates. The estimated radiation dose among pregnant patients who underwent rIVCF placement without adjunct catheter directed thrombolysis (CDT) (mean 695 Gy cm2) was significantly lower than the radiation dose used in postpartum patients (1863 Gy cm2) or in pregnant patients in whom adjunct CDT was utilized (4059 Gy cm2) (p = .001 for both comparisons).Conclusions: Frequent rIVCF-related complications, radiation exposure, and removal failure call for their cautious utilization in obstetric patients. The role of suprarenal placement and elective cesarean section to improve outcomes has yet to be established.

Inferior vena cava filters (IVCFs): a review of uses and application to international guidelines at a single Australian center; implications of venous thromboembolism associated with malignancy.

Venous thromboembolism (VTE) is a potentially lethal event. Anticoagulation is the cornerstone of treatment. Inferior vena cava filters (IVCFs) may be used in circumstances when anticoagulation is contraindicated or as an adjunct to anticoagulation. IVCF use is not without controversy due to concerns over their safety profile, differences in guidelines from international societies, and a limited randomized control trial evidence. We retrospectively undertook a review of IVCF use over a three-year period (2014–2016) at our center, which has a large oncology service but no trauma unit. There were 44 patients with successful IVCF insertion and one patient with an unsuccessful attempt. Indications for insertion included: a contraindication to anticoagulation (n = 28); recurrent VTE on anticoagulation (n = 10); and extensive VTE (n = 7). There were 13 retrieval attempts, of which ten were successful. There were five documented IVCF complications (tilting: n = 2, IVC thrombus: n = 3) with one episode of IVCF failure and two episodes of deep vein thrombosis during the follow-up period. Of the patients, 71% had an active malignancy (of whom 71% had metastatic disease). Seventeen patients died due to progressive malignancy during the study period. There were no life-threatening VTEs or IVCF-associated mortalities. Adherence with published international guidelines was variable. Patients with malignancy were less likely to undergo IVCF retrieval and had a reduced rate of retrieval success. None of the international guidelines comment on the use of IVCFs in patients with malignancy despite being commonly used. IVCF use may be an underappreciated tool in this group.

Rising Retrieval Rates of Inferior Vena Cava Filters in the United States: Insights From the 2012 to 2016 Summary Medicare Claims Data

BackgroundTo determine recent inferior vena cava filter (IVCF) retrieval volumes and rates in the Medicare population. MethodsThe summary Medicare claims data were searched for the years 2012 to 2016 to identify the frequency of IVCF placements and retrievals. The new Healthcare Common Procedure Coding System code for filter retrieval introduced in 2012, 37193, was used to track filter retrievals. Trends in number of IVCF placements and retrievals over the study period were evaluated, both of which were further stratified by physician specialty and site of service. Aggregate and compound annual growth rates for retrievals were also computed. ResultsA total of 255,034 filters were placed over the study period, with the filter placement volume declining from 61,889 in 2012 to 38,095 in 2016. Filter retrievals, however, increased from 4,327 in 2012 to 8,405 in 2016. The net filter retrieval rate per annual filters placed increased from 6.9% in 2012 to 22.1% in 2016, yielding an average filter retrieval rate and compound annual growth rate of 11.6% and 18.1% respectively. Radiologists placed and retrieved the majority of filters (60.4% placed, 63.5% retrieved) compared with nonradiologists. The inpatient setting was the dominant site for filter placement compared with the outpatient setting for filter retrieval across all years and specialties. ConclusionsSince introduction of the unique Healthcare Common Procedure Coding System code for IVCF retrieval in 2012, IVCF placements in the Medicare population have been declining and net retrieval rates have risen. Radiologists continue to place and retrieve the majority of filters.