title: IVC filter retrieval in adolescents: experience in a tertiary pediatric center.
abstract: BACKGROUND
  Inferior vena cava (IVC) filters are commonly implanted with the intent to prevent life-threatening pulmonary embolism in at-risk patients with contraindications to anticoagulation. Various studies have reported increases in the rate of venous thromboembolism within the pediatric population. The utility and safety of IVC filters in children has not yet been fully defined.
  
  
  OBJECTIVE
  To describe the technique and adjunctive maneuvers of IVC filter removal in children, demonstrate its technical success and identify complications.
  
  
  METHODS
  A retrospective 10-year review was performed of 20 children (13 male, 7 female), mean age: 15.1 years (range: 12-19 years), who underwent IVC filter retrieval. Eleven of 20 (55%) were placed in our institution. Electronic medical records were reviewed for filter characteristics, retrieval technique, technical success and complications.
  
  
  RESULTS
  The technical success rate was 100%. Placement indications included: deep venous thrombosis with a contraindication to anticoagulation (10/20, 50%), free-floating thrombus (4/20, 20%), post-trauma pulmonary embolism prophylaxis (3/20, 15%) and pre-thrombolysis pulmonary patient (1/20, 5%). The mean implantation period was 63 days (range: 20-270 days). Standard retrieval was performed in 17/20 patients (85%). Adjunctive techniques were performed in 3/20 patients (15%) and included the double-snare technique, balloon assistance and endobronchial forceps retrieval. Median procedure time was 60 min (range: 45-240 min). Pre-retrieval cavogram demonstrated filter tilt in 5/20 patients (25%) with a mean angle of 17° (range: 8-40). Pre-retrieval CT demonstrated strut wall penetration and tip embedment in one patient each. There were two procedure-related complications: IVC mural dissection noted on venography in one patient and snare catheter fracture requiring retrieval in one patient. There were no early or late complications.
  
  
  CONCLUSIONS
  In children, IVC filter retrieval can be performed safely but may be challenging, especially in cases of filter tilt or embedding. Adjunctive techniques may increase filter retrieval rates.
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. GuzmanA@uphs.upenn.edu.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Guzman
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Zahra
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
authors.affiliation: Department of Pediatrics, Division of Hematology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Raffini
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Itkin
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Keller
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Cahill
mesh_terms: D000293:Adolescent; D015984:Causality; D002648:Child; D015897:Comorbidity; D020878:Device Removal / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D015143:Philadelphia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016306:Vena Cava Filters / Q000706:statistics & numerical data*; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
keywords: Children; Inferior vena cava; Inferior vena cava filter; Inferior vena cava filter retrieval; Interventional radiology; Venous thromboembolism