Manipulation by catheter of unopened LGM filter

The use of the transfemoral and transjugular venous routes for placement of inferior vena cava filters is accepted practice. However, the transjugular route is associated with substantially higher rates of incomplete filter opening for the LGM Vena Tech filter (Vena Tech, Evanston, Ill.). The appropriate course of action when a filter fails to open is unclear from the literature. Current recommendations include close observation or placement of a second filter above the unopened device. The authors report a case in which an incompletely opened filter delivered through the transjugular route was directly manipulated with a multipurpose catheter. The filter opened sufficiently to provide stability and obviate the need for a second filter. The authors recommend that manipulation by catheter be considered as the first option at the time of placement should an LGM filter fail to open completely.