Excimer laser assisted complex inferior vena cava filter retrieval: a single institution's experience over 6 years

Area of Science:

• Vascular Surgery
• Interventional Radiology

Background:

• Inferior vena cava (IVC) filters are used to prevent pulmonary embolism.
• Retrieval of IVC filters can be challenging due to device endothelialization and prolonged indwelling times.

Purpose of the Study:

• To evaluate the efficacy of standard and complex IVC filter retrieval techniques.
• To assess the role of the excimer laser sheath in difficult IVC filter retrievals.

Main Methods:

• Retrospective analysis of 181 attempted IVC filter retrievals over six years.
• Analysis of pre- and perioperative imaging to guide retrieval strategies.
• Comparison of standard retrieval, sling technique, and excimer laser dissection.

Main Results:

• Standard retrieval failed in 28% of cases, often due to endothelialization.
• Complex retrieval, including excimer laser use, was successful in 40 cases.
• Filter foot embedding predicted the need for dissection techniques (p<0.05).
• Mean indwelling time was significantly longer in failed standard retrievals (243 days) versus successful standard retrievals (134 days; p=0.00018).

Conclusions:

• Standard IVC filter retrieval has a notable failure rate, associated with longer indwelling times.
• Preoperative imaging predicting filter embedding is crucial for selecting advanced techniques like the excimer laser sheath.
• The excimer laser sheath is a valuable tool for complex IVC filter retrievals.