187 - Complex IVC Filter Retrieval - Tips and Tricks to Get that Filter Out

Rebecca Le, MD – Integrated Interventional Radiology Fellow, Interventional Radiology, Emory University School of Medicine; Joseph Henain, MD – Attending Physician, Interventional Radiology, JFK Medical Center; Bryan Nicholas Swilley, MD – Assistant Professor, Interventional Radiology, Emory University School of Medicine

Purpose: Prolonged inferior vena cava (IVC) filter dwell time is associated with increased procedural complexity at the time of removal, often due to either abnormal filter positioning or filter endothelization causing the filter to become embedded into the IVC. Complication risks are also increased with complex filter retrieval, though the risks of unsuccessful or unattempted filter retrieval may be considered less than sequelae from continued IVC filter use, which include: filter migration, filter fracture, and/or IVC thrombosis. Herein, we present a case of a patient in their 50s with a history of large B-cell lymphoma and a provoked pulmonary embolism, who initially had a filter for contraindication to anticoagulation but had difficulties in having the filter removed, having two prior failed attempts at prior IVC filter removal two years later.

Material and Methods: Initial venogram showed that the indwelling filter was posteriorly tilted to the left of midline in the IVC with a severe fibrin sheath and could not be removed via snare, the first interventional approach for IVC filter retrieval. Next, the Hangman technique was attempted but was unsuccessful. The filter was successfully retrieved using the Cavaclear Laser sheath (Andover, MA), which performs circumferential scar tissue ablation around an embedded IVC filter using ultraviolet laser energy. This allows faster filter capture immediately following laser activation.

Results: There were no immediate intraprocedural complications during filter retrieval. The patient was safely discharged after the procedure filter-free.

Conclusions: Retrievable IVC filters pose increased risks and complications associated with longer dwell times, suboptimal placement, and tilting. Possessing an ongoing internal escalation plan for complex retrieval is critical, outside of getting the filter out as soon as clinically feasible.