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Review
. 2022 Mar 3:9:746748.
doi: 10.3389/fcvm.2022.746748. eCollection 2022.

Vena Cava Filters: Toward Optimal Strategies for Filter Retrieval and Patients' Follow-Up

Kiara Rezaei-Kalantari  1 , David C Rotzinger  2 , Salah D Qanadli  2
Affiliations
Review

Vena Cava Filters: Toward Optimal Strategies for Filter Retrieval and Patients' Follow-Up

Kiara Rezaei-Kalantari et al. Front Cardiovasc Med. .

Abstract

Mortality rates associated with venous thromboembolism (VTE) are high. Inferior vena cava filters (IVCFs) have been frequently placed for these patients as part of their treatment, albeit the paucity of data showing their ultimate efficacy and potential risk of complications. Issues regarding long-term filter dwell time are accounted for in society guidelines. This topic has led to an FDA mandate for filter retrieved as soon as protection from pulmonary embolism is no longer needed. However, even though most are retrievable, some were inadvertently left as permanent, which carries an incremental lifetime risk to the patient. In the past decade, attempts have aimed to determine the optimal time interval during which filter needs to be removed. In addition, distinct strategies have been implemented to boost retrieval rates. This review discusses current conflicts in indications, the not uncommon complications, the rationale and need for timely retrieval, and different quality improvement strategies to fulfill this aim.

Keywords: IVC filter; IVCF workflow; complications; retrieval strategies; venous thromboembolism.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Technical irretrievability due to thrombus inside the filter. CT venography with axial (a,b), coronally reformatted (c), and sagittally reformatted minimum-intensity projection (d) images show thrombotic material stuck in the filter, precluding retrieval.
Figure 2
Figure 2
Brief review of the obstacles in IVC filter retrieval pathway.
Figure 3
Figure 3
Embedded hook in the IVC wall is a common technical failure reason. CT venography in a patient with an embedded hook is shown on axial (a) and sagittal (b) images. In this case, advanced retrieval with the balloon displacement technique (periprocedural fluoroscopy image, (c) allowed removal. Final transcatheter subtracted cavography (d) shows the absence of complication.
Figure 4
Figure 4
IVC stenosis due to IVCF use, shown in a patient on coronally reformatted pre-retrieval CT venography (a). Post-retrieval subtracted catheter-directed cavography (b) confirms a persistent focal IVC stenosis at the former filter site.
Figure 5
Figure 5
Recommended inferior vena cava filter (IVCF) management, such as implemented by the authors. A clinical follow-up visit at the 5-month time point is critical to achieving appropriate retrieval rates.
See this image and copyright information in PMC

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