The Günther-Tulip retrievable filter: a method for assessing tilting of the filter

Tilting of the Günther-Tulip filter may be responsible for failure or difficulty to retrieve. Assessment of the filter tilt can be difficult when only AP imaging is available. This study is performed in vitro to develop a simple method to assess the Günther-Tulip filter for tilting.

A model consisting of a plastic tube was used to simulate vena cava. A Günther-Tulip filter was placed centred or tilted within the tube at various positions and radiograms were taken in AP, lateral, and craniocaudally angled projections. The images were analysed to determine the actual degree of tilt, the distance between the limb hooks on AP radiograms and the craniocaudal angulation degree needed to align the limb hooks linearly.

When the filter was centred or tilted laterally, all limb hooks of the filter were aligned linearly on AP radiograms. When the filter was tilted in AP or oblique direction, linear alignment of the limb hooks was lost and the ventral and dorsal limb hooks showed separation on AP projection. The amount of separation and the craniocaudal angles to align the filter hooks corresponded to actual tilt angles.

Loss of linear alignment of limb hooks in AP radiograms may suggest the presence of tilt in the AP plane. Significant separation of limb hooks should be alarming for significant filter tilt, and further evaluation of the filter position by CT scan or lateral cavogram should be obtained prior to planning of the retrieval.