title: Techniques used for difficult retrievals of the Günther Tulip inferior vena cava filter: experience in 32 patients.
abstract: OBJECTIVE
  To retrospectively review experience with difficult retrievals of Günther Tulip filters (GTFs) in which various techniques were used.
  
  
  METHODS
  From December 2004 to December 2006, 32 patients were referred to a single radiology department for GTF retrieval (25 women and seven men; mean age, 40 years; range, 21-60 y). All patients were evaluated, and 22 of these patients had undergone unsuccessful filter retrieval attempts elsewhere. In the remaining patients, significant tilt of the filter (n = 8) or difficult internal jugular vein access (n = 2) discouraged retrieval attempts. There were a total of 38 filters. Twenty-five patients had a filter in the infrarenal inferior vena cava (IVC). Among the remaining seven patients, six had bilateral iliac filters and one had a left iliac filter. Retrievals were performed via conventional technique-ie, by snaring the hook of the filter without additional maneuvers-or other techniques.
  
  
  RESULTS
  Thirty-seven of 38 filters were successfully removed, for a success rate of 97%. Successful retrievals were performed with conventional (n = 4), catheter twist (n = 3), modified snare (n = 15), loop snare (n = 14), and balloon dilation (n = 1) techniques. The average dwell time for filters successfully removed was 58 days (range, 22-258 d). One failure occurred in a patient who had undergone unsuccessful retrieval previously. The hook of the filter and a displaced secondary strut, which had migrated superiorly, were incorporated into the IVC wall in this case.
  
  
  CONCLUSIONS
  Additional maneuvers were useful in these difficult retrievals of GTFs that might not otherwise be retrievable with the conventional method.
authors.affiliation: Department of Radiology, University of Chicago Medical Center, Chicago, IL 60637, USA. tgvanha@uchicago.edu
authors.forename: Thuong G
authors.initials: TG
authors.lastname: Van Ha
authors.forename: Olga
authors.initials: O
authors.lastname: Vinokur
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lorenz
authors.forename: Sidney
authors.initials: S
authors.lastname: Regalado
authors.forename: Steven
authors.initials: S
authors.lastname: Zangan
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Piano
authors.forename: Brian
authors.initials: B
authors.lastname: Funaki
mesh_terms: D000328:Adult; D002404:Catheterization; D002405:Catheterization, Central Venous / Q000009:adverse effects; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D055815:Young Adult