Single access 2-snare technique: A novel approach for challenging IVC filter retrieval

The implantation of an Inferior Vena Cava (IVC) filter is an alternate or adjunctive treatment option for preventing pulmonary embolism in patients who are unable to receive anticoagulation therapy or who have a pulmonary embolism recurrence despite anticoagulation therapy. Typically, patients need the filter for only a short duration, after which it can be removed. However, the longer the filter is in place, the more difficult the retrieval can be. Removing the IVC filter is essential for avoiding complications. To increase the success rate of removing filters that have become embedded at the tip, innovative approaches have been developed. The snare technique is a frequently employed technique. We present a case study that demonstrates the single access 2-snare strategy, a revolutionary approach of removing a sophisticated Günther Tulip IVC filter. This technique involves inserting 2 snares into the jugular vein, grasping the filter on both sides, and exerting sufficient force to detach and straighten it from the caval wall. After unsuccessful attempts to advance the filter into the sheath, it was removed immediately from the jugular vein. Hemostasis was attained after a successful withdrawal. The single access 2-snare technique described here provides a novel solution for the difficult retrieval of IVC filters.