IVC filter removal after extended implantation periods

Abstract

Objective: Life-threatening complications have been reported in patients with chronic retrievable IVC filters. National health agencies have urged hospitals to assess all patients with retrievable IVC filters for filter removal. The aim of the current study was to identify those patients with unretrieved chronic IVC filters, document complications and removal techniques.

Methods: We identified a cohort with unretrieved IVC filters inserted between January 2001 and December 2013. These patients were invited back to clinic for review with CT imaging to determine complications, if any, and offer removal. Data collected included demographics, complications and retrieval characteristics.

Results: 289 patients were discovered to still have a filter in situ. Of these, 193 patients were verified as deceased. Eighty-nine patients were notified, with no current contact information available on the remaining seven. Thirty-six attended for review, 20 females, 16 males, with an average age of 63.5 years. Complications identified at CT were 2 occluded IVCs (5.8%), 4 fractured filters (11.7%) and filter penetration in all cases (37.5% grade 2, 56.25% grade 3). Sixteen patients agreed to proceed with filter removal, 10 declined the opportunity and 6 were unfit or had ongoing indication for the filter. Two are awaiting removal and two had IVC occlusion. Subsequent retrieval was successful in 93% of cases (14/15). The mean time to removal from implant was 3846.9 days (SD 980.3). Advanced techniques were utilized in 10 cases and there were no mortalities or morbidities.

Conclusion: Retrievable inferior vena cava filters are not benign and practitioners need to be aware of regulatory guidelines. Unretrieved filters can be successfully retrieved using standard and advanced methods with low morbidity and mortality.

Keywords: Deep venous thrombosis; IVC filter; Pulmonary embolism.