Percutaneous Retrieval of Permanent Inferior Vena Cava Filters.
OBJECTIVE
To evaluate the feasibility, risks, and techniques of percutaneous removal of permanent TrapEase and Simon Nitinol IVC filters.


METHODS
Between August 2011 and August 2015, 12 patients (5 women, 7 men; age range, 26-75 years) underwent an attempt at percutaneous removal of permanent TrapEase (10) and Simon Nitinol (2) IVC filters due to a history of IVC filter complications or need for lifelong anticoagulation due to the filter. Medical records were reviewed for filter dwell time, presence of iliocaval deep venous thrombosis, procedural technique, and complications.


RESULTS
Filter dwell times ranged from 7 days to 15 years (mean 5.1 years). Successful removal of permanent IVC filters was possible in 11 of 12 patients (91.6%). In 1 patient, a chronically thrombosed IVC filter could not be removed despite laser sheath assistance, but was successfully recanalized with the PowerWire RF guidewire. In the failed retrieval attempt, a stent was placed through the chronically thrombosed IVC filter with restoration of in-line flow. One major complication of large venous groin hematoma was encountered.


CONCLUSIONS
In carefully selected patients, percutaneous removal of permanent IVC filters can be performed safely despite prolonged filter dwell times. Extraction of chronically embedded permanent IVC filters may be facilitated by jugular and femoral approaches, often with laser sheath assistance. Chronic filter thrombosis and caval scarring may increase the risk of retrieval failure.
Division of Vascular & Interventional Radiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheik Zayed Towers, Suite 7203, Baltimore, MD, 21287, USA. atamraz1@jhmi.edu.
Anobel
A
Tamrazi
Division of Vascular & Interventional Radiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheik Zayed Towers, Suite 7203, Baltimore, MD, 21287, USA. vwadhwa1@jhmi.edu.|Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA. vwadhwa1@jhmi.edu.
Vibhor
V
Wadhwa
Division of Vascular & Interventional Radiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheik Zayed Towers, Suite 7203, Baltimore, MD, 21287, USA. bholly3@jhmi.edu.
Brian
B
Holly
Division of Vascular & Interventional Radiology, Kaiser Permanente, McLean, VA, USA. nikhibhagat@gmail.com.
Nikhil
N
Bhagat
Division of Vascular & Interventional Radiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheik Zayed Towers, Suite 7203, Baltimore, MD, 21287, USA. jmarx9@jhmi.edu.
Jonathan K
JK
Marx
Department of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. mstreif@jhmi.edu.
Michael
M
Streiff
Division of Vascular & Interventional Radiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheik Zayed Towers, Suite 7203, Baltimore, MD, 21287, USA. mlessne@gmail.com.|Vascular & Interventional Specialists of Charlotte Radiology, Charlotte, NC, USA. mlessne@gmail.com.
Mark L
ML
Lessne
D000328:Adult; D000368:Aged; D020878:Device Removal / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016306:Vena Cava Filters / Q000009:adverse effects*; D014682:Vena Cava, Inferior / Q000601:surgery*; D054556:Venous Thromboembolism / Q000517:prevention & control*
IVC filter; Inferior vena cava; Simon Nitinol; TrapEase