A 16-F Sheath with Endobronchial Forceps Improves Reported Retrieval Success of Long-Dwelling “Closed Cell” Inferior Vena Cava Filter Designs

• Published in: Journal of vascular and interventional radiology Vol. 27; no. 7; pp. 1027 - 1033
• Main Authors: Chick, Jeffrey Forris Beecham, MD, MPH, Stavropoulos, S. William, MD, Shin, Benjamin J., MD, Shlansky-Goldberg, Richard D., MD, Mondschein, Jeffrey I., MD, Sudheendra, Deepak, MD, Nadolski, Gregory J., MD, Watts, Micah M., MD, Trerotola, Scott O., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2016
• Subjects: Adult; Aged; Aged, 80 and over; Device Removal - adverse effects; Device Removal - instrumentation; Device Removal - methods; Equipment Design; Female; Fluoroscopy; Humans; Male; Middle Aged; Philadelphia; Phlebography; Prosthesis Design; Prosthesis Implantation - instrumentation; Radiography, Interventional - methods; Radiology; Retrospective Studies; Surgical Instruments; Time Factors; Treatment Outcome; Vena Cava Filters; Vena Cava, Inferior - diagnostic imaging; Young Adult; inferior vena cava; IVC
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2016.03.047

Abstract Purpose To report results of a 16-F sheath/endobronchial forceps combination in retrieval of “closed cell” inferior vena cava (IVC) filter designs with prolonged dwell times of ≥ 60 days. Materials and Methods Forceps retrieval of selected IVC filters using a 16-F 45-cm sheath was performed in 35 patients (25 women and 10 men). Patients presented with filters that were no longer needed without (n = 10) or with (n = 21) prior failed retrieval, caval thrombosis before lysis (n = 3), and back pain (n = 1). Filter designs included 19 Günther Tulip (54%), 10 Option (29%), and six OptEase (17%). Mean dwell time was 977 days. Imaging characteristics, technical success, fluoroscopy time, and complications were recorded. Results Filters included 20 tip-embedded, 6 tip-adherent, 4 fractured, and 6 containing thrombus. All were strut and wall-embedded. Initial snare failures occurred in 8 filters because of hook straightening (n = 4), adherent material (n = 2), snare breakage (n = 1), and filter tilt (n = 1). The 16-F sheath/forceps combination was 100% successful in removing filters. In 1 patient, 2 extravascular fragments could not be retrieved. Median fluoroscopy time, excluding 3 extended lysis procedures, was 8 minutes. Minor caval abnormalities, including caval spasm and caval defects, were noted in 17 patients, and filter fracture occurred in 2 patients. No major complications occurred. Conclusions A high rate of retrieval for closed cell long-dwelling strut and wall-embedded filters may be achieved using a 16-F sheath/endobronchial forceps combination.