title: Complex retrieval of embedded IVC filters: alternative techniques and histologic tissue analysis.
abstract: OBJECTIVE
  We evaluated the safety and effectiveness of alternative endovascular methods to retrieve embedded optional and permanent filters in order to manage or reduce risk of long-term complications from implantation. Histologic tissue analysis was performed to elucidate the pathologic effects of chronic filter implantation.
  
  
  METHODS
  We studied the safety and effectiveness of alternative endovascular methods for removing embedded inferior vena cava (IVC) filters in 10 consecutive patients over 12 months. Indications for retrieval were symptomatic chronic IVC occlusion, caval and aortic perforation, and/or acute PE (pulmonary embolism) from filter-related thrombus. Retrieval was also performed to reduce risk of complications from long-term filter implantation and to eliminate the need for lifelong anticoagulation. All retrieved specimens were sent for histologic analysis.
  
  
  RESULTS
  Retrieval was successful in all 10 patients. Filter types and implantation times were as follows: one Venatech (1,495 days), one Simon-Nitinol (1,485 days), one Optease (300 days), one G2 (416 days), five Günther-Tulip (GTF; mean 606 days, range 154-1,010 days), and one Celect (124 days). There were no procedural complications or adverse events at a mean follow-up of 304 days after removal (range 196-529 days). Histology revealed scant native intima surrounded by a predominance of neointimal hyperplasia and dense fibrosis in all specimens. Histologic evidence of photothermal tissue ablation was confirmed in three laser-treated specimens.
  
  
  CONCLUSIONS
  Complex retrieval methods can now be used in select patients to safely remove embedded optional and permanent IVC filters previously considered irretrievable. Neointimal hyperplasia and dense fibrosis are the major components that must be separated to achieve successful retrieval of chronic filter implants.
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: John S
authors.initials: JS
authors.lastname: Cupp
authors.forename: John D
authors.initials: JD
authors.lastname: Louie
authors.forename: Nishita
authors.initials: N
authors.lastname: Kothary
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Hofmann
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
authors.forename: David M
authors.initials: DM
authors.lastname: Hovsepian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000925:Anticoagulants / Q000008:administration & dosage; D020878:Device Removal; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000517:prevention & control; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional; D016306:Vena Cava Filters / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants