title: A "fall-back" technique for difficult inferior vena cava filter retrieval.
abstract: OBJECTIVE
  The purpose of this study was to describe the results of an alternative technique for inferior vena cava filter (IVCF) retrieval that can be used when the retrieval hook cannot be snared.
  
  
  METHODS
  Retrospective review of all patients undergoing attempted IVCF retrieval by a single surgeon between March 2009 and March 2011 was undertaken. After December 2009, in cases where the retrieval hook could not be snared, an 18F/85 cm sheath was inserted into the internal jugular vein and a Bentson wire (Cook Medical, Bloomington, Ind) and snare were advanced across separate interstices of the filter. The resulting "lasso" was pulled up below the collar at the top of the filter, and the filter collapsed into the sheath.
  
  
  RESULTS
  Over 28 months, 34 patients underwent attempted retrieval of Günther Tulip filters (Cook Medical). Patients were 44±15 years old; 59% were women (n=20). Filters were placed for venous thromboembolism with contraindication to anticoagulation in seven cases and prophylactically in 27 cases. Of the prophylactic cases, 18 (67%) were placed before planned bariatric surgery. Before December 2009, the success rate was 86% (6 of 7): the retrieval hook of one filter could not be snared and seemed to be embedded in the wall of the cava. After adoption of the described technique, the success rate was 96% (26 of 27): one patient refused further attempts at central venous catheterization after multiple unsuccessful attempts. Filters retrieved conventionally by snaring the hook (n=18) were implanted on average for 4.8±3.7 months and 12.1±10.1 months for those retrieved using the new technique (n=14; P=.02). All patients were discharged on the day of the procedure without complication. The one patient in whom the retrieval hook could not be snared before December 2009 has refused another attempt at retrieval.
  
  
  CONCLUSIONS
  The method of IVCF retrieval described here was successful in every instance in which it was attempted. It was associated with no morbidity despite the customary use of an 18F sheath in the internal jugular vein. The approach constitutes an appropriate "fall-back" technique when the retrieval hook of a removable IVCF cannot be snared.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. foleyp@uphs.upenn.edu
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Foley
authors.forename: Derek P
authors.initials: DP
authors.lastname: Nathan
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Wang
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Woo
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
mesh_terms: D000328:Adult; D020878:Device Removal / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D016306:Vena Cava Filters