Forceps retrieval of long-dwelling permanent inferior vena cava filters: technical success and complications

To report the rate of technical success and procedural outcomes of forceps retrieval techniques for removing long-dwelling "permanent" inferior vena cava (IVC) filters.

Retrospective single center analysis identified 34 patients, including 19 (55.9%) males and 15 (44.1%) females, with mean age of 52 years (range 21-71 years), meeting inclusion criteria of having a "permanent" IVC filter removed. Mean filter dwell time was 112 months (range 8-337 months). Indications for "permanent" filter retrieval included iliocaval thrombosis (n = 23; 67.6%), strut fracture or migration (n = 6; 17.6%), patient request (n = 4; 11.8%), and future open thoracoabdominal aortic aneurysm repair (n = 1; 2.9%).

"Permanent" filters included Greenfield (n = 16; 47.1%), TrapEase (n = 10; 29.4%), Simon Nitinol (n = 5; 14.7%), VenaTech LP (n = 2; 5.9%), and Bird's Nest (n = 1; 2.9%). The 3-mm endobronchial forceps were used in 30 (88.2%) patients and the 2.25-mm myocardial forceps were used in 4 (11.8%) patients. Technical success was 88.2% (30/34). Mean fluoroscopy time was 75.1 min (range 10-230 min) for the entire procedure (including venous stent reconstructions, if required). Three (8.9%) patients, with Greenfield, TrapEase, and Bird's Nest removals, developed small IVC intimal injuries and pseudoaneurysms resulting in contained leaks with no long-term complications. One (2.9%) patient suffered a thromboembolic stroke following retrieval of a TrapEase filter which ultimately resulted in death. Mean follow-up duration was 647 days (range 27-2,265 days).

Forceps retrieval of long-dwelling permanent IVC has a high rate of technical success with risk of injury to the IVC or thromboembolism. With appropriate discussion of the risks and benefits, a variety of long-dwelling "permanent" IVC filters can be removed.