Removable vena cava filter: single-centre experience with a single device

The aim of our study was to evaluate the safety of retrieving both short- and long-term permanent/ retrievable ALN vena cava filters (VCF).

From 2002 to 2010, 201 permanent/retrievable VCF were percutaneously placed in 201 patients (age range, 18-80 years). Sixty-seven were placed through the jugular vein, 61 through the brachial vein and 63 through the femoral vein. In 109 patients, the VCF was placed for absolute indications, in 77 for relative indications, and in 15 for temporary filtration. Follow-up was carried out with colour Doppler ultrasound (CDUS) and abdominal X-ray at 3 and 12 months, then annually. Indications for removal included: lack of contraindications to anticoagulant therapy, absence of pulmonary embolism and iliocaval venous patency. All candidates for VCF removal underwent computed tomography angiography (CTA).

VCF placement with correct position (tilting up to 15°) was achieved in 99.01% of cases. In two (0.99%) cases, tilting >15° was present. Haematomas, which resolved spontaneously, occurred in only eight jugular access sites. A total of 26 of 201 VCF were removed, with 96.16% technical success. The removal procedure failed in one case only. In seven cases, a double approach through the right jugular and femoral veins was necessary. VCF was removed 6 months after deployment in 11 patients, 12 months in eight, 24 months in four after 36 months in three (range, 180-1,155 days.) There were no periprocedural complications. Of the 26 removed VCF, 21 were infrarenal and five suprarenal. Of the 15 VCF placed for temporary use, 12 were removed; the remaining three not removed owing to persistence of the neoplastic thrombus after nephrectomy for kidney cancer. Of the 186 VCF placed for permanent use, with absolute and relative indications, 14 were removed (4/109 and 10/77, respectively). Only one showed thrombi occluding the cranial end.

VCF removal is certainly more difficult than placement. Technical failure of the removal procedure is directly proportional to the VCF tilt, and the VCF is as yet unable to ensure absolute removal safety, with the result that failure may occasionally occur. The morphological and structural features of permanent/retrievable VCF allow for unlimited time from placement to removal, documented to be up to 3 years after placement.