title: Photothermal ablation with the excimer laser sheath technique for embedded inferior vena cava filter removal: initial results from a prospective study.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of the excimer laser sheath technique for removing embedded inferior vena cava (IVC) filters.
  
  
  METHODS
  Over 12 months, 25 consecutive patients undergoing attempted IVC filter retrieval with a laser-assisted sheath technique were prospectively enrolled into an institutional review board-approved study registry. There were 10 men and 15 women (mean age 50 years, range 20-76 years); 18 (72%) of 25 patients were referred from an outside hospital. Indications for retrieval included symptomatic filter-related acute caval thrombosis (with or without acute pulmonary embolism), chronic IVC occlusion, and bowel penetration. Retrieval was also performed to remove risks from prolonged implantation and potentially to eliminate need for lifelong anticoagulation. After failure of standard methods, controlled photothermal ablation of filter-adherent tissue with a Spectranetics laser sheath and CVX-300 laser system was performed. All patients were evaluated with cavography, and specimens were sent for histologic analysis.
  
  
  RESULTS
  Laser-assisted retrieval was successful in 24 (96%) of 25 patients as follows: 11 Günther Tulip (mean 375 days, range 127-882 days), 4 Celect (mean 387 days, range 332-440 days), 2 Option (mean 215 days, range 100-330 days), 4 OPTEASE (mean 387 days, range 71-749 days; 1 failed 188 days), 2 TRAPEASE (mean 871 days, range 187-1,555 days), and 2 Greenfield (mean 12.8 years, range 7.2-18.3 years). There was one (4%) major complication (acute thrombus, treated with thrombolysis), three (12%) minor complications (small extravasation, self-limited), and one adverse event (coagulopathic retroperitoneal hemorrhage) at follow-up (mean 126 days, range 13-302 days). Photothermal ablation of filter-adherent tissue was histologically confirmed in 23 (92%) of 25 patients.
  
  
  CONCLUSIONS
  The laser-assisted sheath technique appears to be a safe and effective tool for retrieving embedded IVC filters, including permanent types, with implantation ranging from months to > 18 years.
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3651, Stanford, CA 94305-5642, USA. wkuo@stanford.edu
authors.forename: William T
authors.initials: WT
authors.lastname: Kuo
authors.forename: Justin I
authors.initials: JI
authors.lastname: Odegaard
authors.forename: John D
authors.initials: JD
authors.lastname: Louie
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
authors.forename: Kamil
authors.initials: K
authors.lastname: Unver
authors.forename: Nishita
authors.initials: N
authors.lastname: Kothary
authors.forename: Jarrett K
authors.initials: JK
authors.lastname: Rosenberg
authors.forename: David M
authors.initials: DM
authors.lastname: Hovsepian
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Hwang
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Hofmann
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D020878:Device Removal; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000009:adverse effects*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055815:Young Adult