Excimer laser-assisted removal of embedded inferior vena cava filters: a single-center prospective study
William T Kuo1, Justin I Odegaard, Jarrett K Rosenberg
1Division of Vascular and Interventional Radiology, Department of Radiology and Department of Pathology, Stanford University Medical Center, Stanford, CA.
Insights
Excimer laser-assisted removal effectively retrieves embedded inferior vena cava filters when standard methods fail. This safe technique alleviates filter-related morbidity and allows patients to stop anticoagulation.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Medical Device Technology
Background:
- Chronically implanted inferior vena cava (IVC) filters can cause morbidity.
- No routine method exists for removing embedded IVC filters.
- Embedded filters pose risks, including thrombosis and penetration.
Purpose of the Study:
- To evaluate the efficacy and safety of excimer laser-assisted removal for embedded IVC filters.
- To assess the reduction in retrieval force compared to standard methods.
- To determine the impact on filter-related morbidity and anticoagulation requirements.
Main Methods:
- Prospective single-center study of 100 consecutive patients over 3 years.
- Photothermal tissue ablation using a 308-nm xenon chloride excimer laser sheath after standard retrieval failure.
- Measurement of applied forces before and during laser activation.
- Histological confirmation of scar tissue ablation.
Main Results:
- Successful laser-assisted retrieval in 98.0% of cases, with a mean implantation of 855 days.
- Significantly lower average force during laser-assisted retrieval (4.6 lbs) compared to failed standard retrievals (7.2 lbs).
- Major complication rate of 3.0%, minor complication rate of 7.0%, and 4.0% adverse events.
- Scar tissue ablation confirmed in 96.0% of cases.
- 100% of patients (30/30) discontinued anticoagulation post-retrieval.
- 96% of patients (23/24) experienced alleviation of morbidity.
Conclusions:
- Excimer laser-assisted removal is an effective and safe method for embedded IVC filters resistant to standard retrieval.
- This technique can prevent and alleviate IVC filter-related morbidity.
- Laser-assisted removal facilitates cessation of anticoagulation and improves patient outcomes.
Background:
Although chronically implanted inferior vena cava filters may result in filter-related morbidity, there is currently no routine option for removing such filters when they become firmly embedded along the vena cava endothelium.
Methods And Results:
During a 3-year period, 100 consecutive patients were prospectively enrolled in a single-center study. There were 42 men and 58 women (mean age, 46 years; limits, 18-76 years). Retrieval indications included filter-related acute inferior vena cava thrombosis, chronic inferior vena cava occlusion, and pain from retroperitoneal or bowel penetration. Filter retrieval was also performed to prevent risks from prolonged implantation and to potentially eliminate the need for lifelong anticoagulation. After standard methods failed, photothermal tissue ablation was attempted with a laser sheath powered by a 308-nm xenon chloride excimer laser. Applied forces were recorded with a digital tension meter before and during laser activation. Laser-assisted retrieval was successful in 98.0% (95% confidence interval [CI], 93.0%-99.8%) with mean implantation of 855 days (limits, 37-6663 days; >18 years). The following filter types were encountered in this study: Günther-Tulip (n=34), Celect (n=12), Option (n=17), Optease (n=20, 1 failure), TrapEase (n=6, 1 failure), Simon-Nitinol (n=1), 12F Stainless Steel Greenfield (n=4), and Titanium Greenfield (n=6). The average force during failed standard retrievals was 7.2 versus 4.6 pounds during laser-assisted retrievals (P<0.0001). The major complication rate was 3.0% (95% CI, 0.6%-8.5%), the minor complication rate was 7.0% (95% CI, 0.3%-13.9%), and there were 4 adverse events (2 coagulopathic hemorrhages, 1 renal infarction, and 1 cholecystitis; 4.0%; 95% CI, 1.1%-9.9%) at mean follow-up of 500 days (limits, 84-1079 days). Scar tissue ablation was histologically confirmed in 96.0% (95% CI, 89.9%-98.9%). Successful retrieval allowed cessation of anticoagulation in 30 of 30 (100%) patients and alleviated morbidity in 23 of 24 patients (96%).
Conclusions:
Excimer laser-assisted removal is effective in removing embedded inferior vena cava filters refractory to standard retrieval and high force. This method can be safely used to prevent and alleviate filter-related morbidity.
Clinical Trial Registration Url:
http://www.clinicaltrials.gov. Unique identifier: NCT01158482.
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