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 VS5. Challenging Inferior Vena Cava Filter Retrieval

Paul J. Foley, Grace J. Wang, Benjamin J. Herdrich, Erin H. Murphy, Bruce P. Landau, Edward Y. Woo, Ronald M. Fairman, Benjamin M. Jackson
Surgery, University of Pennsylvania, Philadelphia, PA.
BACKGROUND: Placement of inferior vena cava filters (IVCF) in the United States has increased dramatically over the last 3 decades, partly due to the popularity of retrievable filter use. Complications of prolonged IVCF dwell times include an increased risk of deep venous thrombosis and caval thrombosis as well as filter migration and erosion through the caval wall. In 2010, the FDA issued a safety advisory addressing the growing trend of retrievable IVC filter placement, urging implanting physicians and clinicians responsible for the ongoing care of patients with retrievable IVC filters to consider removing the filter as soon as protection from PE is no longer needed.
TECHNICAL DESCRIPTION: Difficult retrieval of IVCFs due to tilting of the filter, inability to snare the hook or penetration of the filter struts through the caval wall, have been reported using a variety of techniques. This video will demonstrate several commonly-encountered challenges in IVCF retrieval, from navigating a wire from the right internal jugular vein into the IVC to the inability to snare the retrieval hook. The focus of the video is the demonstration of a snared-wire technique for challenging IVCF retrieval when the traditional snare technique fails. An 18-Fr sheath (85 cm) is inserted over a stiff wire to the level of the filter. A wire and snare catheter are then maneuvered so that they pass through separate interstices of the filter. The wire is snared caudad to the filter legs and the resulting “lasso” is pulled up below the filter collar. The 18-Fr sheath is then advanced over the filter to collapse the filter legs. We have achieved technical success rates of 96% since adopting this technique 2 years ago with the single failed attempt occurring in a patient who refused further attempts at central venous catheterization following multiple unsuccessful attempts. With such high rates of technical success efforts should now be focused on methods to improve follow-up in patients with retrievable IVC filters.
AUTHOR DISCLOSURES: R. M. Fairman, Nothing to disclose; P. J. Foley, Nothing to disclose; B. J. Herdrich, Nothing to disclose; B. M. Jackson, Nothing to disclose; B. P. Landau, Nothing to disclose; E. H. Murphy, Nothing to disclose; G. J. Wang, Nothing to disclose; E. Y. Woo, Nothing to disclose.
Posted April 2012

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