Inferior Vena Cava Filters in the Asymptomatic Chronically Occluded Cava: To Remove or Not Remove?

Risks of IVC filter insertion are numerous but include IVC stenosis or thrombosis and may result in caval occlusion. Acute IVC occlusion is almost always symptomatic, and treatment can be aggressive such as catheter-directed thrombolysis or conservative such as anticoagulation. The more challenging cohort of patients is those where there has been chronic complete occlusion of the IVC without symptoms, sometimes only identified at the time of routine filter retrieval. We explore the available evidence and discuss different management approaches in this circumstance ranging from aggressive to conservative. However, given that the overall incidence of filter-related complications is very low, at this stage we find no compelling evidence to support aggressive management without symptoms.