Retrievable inferior vena cava filters can always be removed using "fall-back" techniques

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Device Retrieval

Background:

• Prolonged dwell time of retrievable inferior vena cava filters (IVCFs) increases risks of complications like migration, fracture, and thrombosis.
• Standard IVCF retrieval methods can be challenging, necessitating advanced techniques for successful removal.

Purpose of the Study:

• To evaluate the impact of incorporating novel "fall-back" techniques on the outcomes of IVCF retrievals.
• To analyze the safety and efficacy of these advanced methods in a tertiary academic medical center over a 5-year period.

Main Methods:

• A retrospective analysis of patients undergoing IVCF removal between 2009 and 2013.
• Standard snaring was attempted first, followed by fall-back techniques (endoscopic graspers, 18F sheaths, secondary wire snaring) if initial attempts failed.
• Data collected included patient demographics, procedural details, and filter characteristics.

Main Results:

• A total of 268 IVCFs were successfully retrieved (98.5% success rate).
• Fall-back techniques were used in 21% of cases, achieving 100% technical success.
• Filters removed using fall-back techniques had a significantly longer median dwell time (173 days vs. 83 days).
• Four intraoperative complications occurred, involving fractured wires that were successfully retrieved endovascularly.

Conclusions:

• Incorporation of fall-back techniques can achieve 100% technical success in retrievable IVCF removal.
• These advanced methods are particularly beneficial for retrieving IVCFs with extended indwelling periods.
• The study supports the safety and efficacy of fall-back techniques for complex IVCF retrievals.