title: Factors Associated with Advanced Inferior Vena Cava Filter Removals: A Single-Center Retrospective Study of 203 Patients Over 7 Years.
abstract: OBJECTIVE
  To identify factors associated with advanced inferior vena cava filter (IVCF) retrieval to raise awareness on technical considerations, retrieval efficiency, and patient safety.
  
  
  METHODS
  A single-center retrospective review was performed of 203 consecutive retrievable IVC filters placed between 2007 and 2014. Attempted retrievals were classified as advanced if the routine "snare and sheath" technique was initially unsuccessful after multiple attempts, or an alternate endovascular maneuver or access site was utilized. Patient and filter characteristics were recorded.
  
  
  RESULTS
  203 attempted retrievals were reviewed (48.7 % male, 51.2 % female, mean age 52.7 years, mean dwell time 109 days). Advanced retrievals were observed in 20 patients (9.8 %) (15 females, 5 males). Fluoroscopy time (p ≤ 0.01, 34.3 ± 21.1 and 5.3 ± 4.5 min for advanced retrievals and routine retrievals respectively, same below), gender (p = 0.031), and retrieval tilt angle (p ≤ 0.01, 5.7 ± 5.10° vs. 11.9 ± 11.03°) were associated with advanced retrievals. Females were 3.16 times more likely to have an advanced retrieval performed than males with a significantly higher tilt angle in those with advanced retrieval. History of cancer (p = 0.502), dwell time (p = 0.916), retrieval caval diameter (p = 0.053), placement caval diameter (p = 0.365), filter type (p = 0.710), strut perforation (p = 0.506), placement tilt angle (p = 0.311), and age (p = 0.558) were not found significantly associated with advanced retrievals.
  
  
  CONCLUSIONS
  Women are at increased risk for advanced filter retrieval secondary to a significant change in filter tilt over time compared to men, independent of filter type or competing demographic or filter risks, likely placing them at increased risk for higher procedural fluoroscopy times.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Suite, Columbus, OH, 43210, USA. Joshua.Dowell@osumc.edu.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Dowell
authors.affiliation: Department of Radiology, Division of Interventional Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Suite, Columbus, OH, 43210, USA. Daniel.Wagner@osumc.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wagner
authors.affiliation: Department of Radiology, Division of Interventional Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Suite, Columbus, OH, 43210, USA. Eric.Elliott@osumc.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Elliott
authors.affiliation: Center for Biostatistics, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Suite, Columbus, OH, 43210, USA. Vedat.Yildiz@osumc.edu.
authors.forename: Vedat O
authors.initials: VO
authors.lastname: Yildiz
authors.affiliation: Center for Biostatistics, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Suite, Columbus, OH, 43210, USA. Jeff.Pan@osumc.edu.
authors.forename: Xueliang
authors.initials: X
authors.lastname: Pan
mesh_terms: D020878:Device Removal; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior
keywords: IVC filter; Retrieval; Women