title: Technical and patient-related characteristics associated with challenging retrieval of inferior vena cava filters.
abstract: OBJECTIVE
  To identify patient-related and device-specific predictors of challenging and failed inferior vena cava (IVC) filter retrievals.
  
  
  METHODS
  Retrospective single center review of consecutive retrievable IVC filters placed between 2004 and 2009. Retrieval was defined as challenging when it was unsuccessful owing to reported technical failure or when adjunctive endovascular maneuvers or access sites were recruited. Data regarding patient- and filter-specific information were collected. Logistic regression models were used to identify predictors of the reported outcomes. Statistical significance was set at p < .05.
  
  
  RESULTS
  Four hundred and one patients underwent retrievable IVC filter placement-the majority indicated for prophylaxis (67%). Two hundred and fifty-nine retrievals were attempted and 237 filters were successfully retrieved (overall retrieval rate: 59.1%). Eleven out of 259 (4.2%) attempts were aborted owing to significant thrombus within the filter and 11 (4.2%) were technically unsuccessful. In 142 patients no attempt for filter retrieval was made-the major reason being physician oversight (44.3%). Thirty-eight out of 248 (15.3%) non-aborted filter retrievals were recorded as challenging. Failed retrievals were predicted by prolonged dwell time (96.9 ± 111.9 vs. 29.5 ± 25.1 days, odds ratio [OR] 1.034, 95% confidence interval [CI] 1.016-1.053, p < .001), therapeutic indication (OR 5.197, 95% CI 1.200-22.511, p = .028), and filter wall apposition (OR 11.857, 95% CI 2.069-67.968, p = .006). Challenging retrievals were predicted by dwell time (51.1 ± 69.8 vs. 29.1 ± 24.5 days, OR 1.017, 95% CI 1.005-1.029, p = .007), filter tilt (OR 2.607, 95% CI 1.045-6.508, p = .040) and filter wall apposition (OR 6.149, 95% CI 2.398-15.763, p = <.001).
  
  
  CONCLUSIONS
  Physician oversight leads to poor IVC filter retrieval rates. Retrievals can be challenging or fail when the dwell time is >50 days and >90 days, respectively, and when the filter hook apposes the caval wall. Filter tilt increases retrieval difficulty but not failure rates.
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15217, USA.
authors.forename: E D
authors.initials: ED
authors.lastname: Avgerinos
authors.forename: J
authors.initials: J
authors.lastname: Bath
authors.forename: J
authors.initials: J
authors.lastname: Stevens
authors.forename: B
authors.initials: B
authors.lastname: McDaniel
authors.forename: L
authors.initials: L
authors.lastname: Marone
authors.forename: E
authors.initials: E
authors.lastname: Dillavou
authors.forename: J S
authors.initials: JS
authors.lastname: Cho
authors.forename: M S
authors.initials: MS
authors.lastname: Makaroun
authors.forename: R A
authors.initials: RA
authors.lastname: Chaer
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D020878:Device Removal; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000150:complications* / Q000209:etiology
keywords: Deep venous thrombosis; IVC filter; IVC filter complications; IVC filter retrieval; Pulmonary embolism