Technical and Patient-related Characteristics Associated with Challenging Retrieval of Inferior Vena Cava Filters

• Published in: European journal of vascular and endovascular surgery Vol. 46; no. 3; pp. 353 - 359
• Main Authors: Avgerinos, E.D, Bath, J, Stevens, J, McDaniel, B, Marone, L, Dillavou, E, Cho, J.S, Makaroun, M.S, Chaer, R.A
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-09-2013
• Subjects: Adult; Aged; Chi-Square Distribution; Deep venous thrombosis; Device Removal; Female; Humans; IVC filter; IVC filter complications; IVC filter retrieval; Logistic Models; Male; Middle Aged; Pulmonary embolism; Pulmonary Embolism - prevention & control; Retrospective Studies; Risk Factors; Surgery; Time Factors; Treatment Failure; Vena Cava Filters; Venous Thrombosis - complications; Venous Thrombosis - etiology; IVC filter complications; Pulmonary embolism; Deep venous thrombosis; IVC filter retrieval; IVC filter
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2013.06.007

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.