Penetration of bone by inferior vena cava filters: safety and technical success of percutaneous retrieval

Abstract Purpose : The technical success and safety of percutaneous IVCF retrieval when filter elements are penetrating into adjacent bony structures is unknown. Therefore, our purpose was to evaluate the technical success and safety of IVCF retrieval when filter elements are penetrating into adjacent bone. Materials and methods : Using percutaneous IVCF retrievals from 2008-2018 in adult patients, we conducted a multi-institutional, retrospective review of filters found to penetrate lumbar vertebrae by CT scans. Technical success following the retrieval procedure was recorded. Patient records were assessed for complications from retrieval. Results : 13 patients (2 males; 11 females; mean age: 53.2 years (range: 22-71) were included. 100% of the filters were optional (“retrievable”) filters. Venous thromboembolism (VTE) with a contraindication to anti-coagulation (n=7; 53.8%) and prophylaxis without VTE (n=3; 23.1%) were the two most common indications for IVCF placement. Two filters (15.4%) had >15 degrees of tilt relative to the IVC prior to retrieval while no IVCFs had migrated or caused caval thrombosis. One filter (7.7%) was found to have a fractured strut prior to retrieval. Ten patients (76.9%) were either on anti-coagulants or anti-platelet medications at the time of retrieval. No patients were on antibiotics and no patients received peri-procedural antibiotics. Median dwell time was 116.5 days (range: 49-5395). All 13 IVCFs were successfully retrieved in a single session (technical success: 100%). Standard snare technique was used in eight cases (61.5%), endobronchial forces were used in three cases (23.1%), and wire loop snare technique was used in two cases (15.4%). There were no complications in any patient. Conclusion : Percutaneous retrieval of IVCFs with elements that have penetrated into adjacent vertebrae is both safe and technically feasible.