Direct superior vena cava puncture for inferior vena cava filter retrieval

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Cardiology

Background:

• Inferior vena cava (IVC) filters are typically retrieved via a superior approach.
• Retrieval is challenging when central chest veins are occluded, often due to thrombosis.
• Fractured IVC filters pose a risk and necessitate effective retrieval strategies.

Purpose of the Study:

• To describe a novel technique for retrieving a fractured IVC filter in a patient with bilateral brachiocephalic vein thrombosis.
• To evaluate the feasibility and safety of direct superior vena cava (SVC) access for IVC filter retrieval.

Main Methods:

• Direct SVC puncture from the lower neck under fluoroscopic guidance.
• Use of a snare inserted via the common femoral vein as a radiopaque target for SVC puncture.
• Confirmation of a safe access trajectory using cone beam computed tomography and pullback tractography.
• Successful retrieval of the fractured IVC filter using forceps.

Main Results:

• The described technique allowed for successful retrieval of a fractured IVC filter.
• Direct SVC access was achieved safely, guided by imaging modalities.
• The patient tolerated the procedure without immediate complications.

Conclusions:

• Direct SVC access is a feasible and potentially life-saving approach for IVC filter retrieval in patients with central venous occlusion.
• This technique provides an alternative when standard superior retrieval methods are not possible.
• Further studies are warranted to establish the broader applicability of this method.