Objective: This is a case report of a 52 year old male with a history of ulcerative colitis and right lower extremity DVT requiring IVC filter placement due to GI bleed. Patient presented to vascular surgery clinic for IVC filter retrieval 7 years after its placement. CT venogram showed malpositioned IVC filter with 4/6 legs penetrating outside of the wall of the IVC into the aorta and extending to the spine. (Figure A)
Methods: Right internal jugular vein, right common femoral vein, and left common femoral artery were accessed under ultrasound guidance. We passed a glidewire through the right IJ access into the IVC where snare was used to capture the wire and bring it through the right CFV sheath. The laser was advanced through the right IJ access and positioned above the level of the filter. Using the snare, several attempts were made to capture the tip of the filter but the tip was embedded into the in the sidewall of the IVC. “Hangman’s loop” technique was used to pull the tip into the catheter. This was successful. We utilized the laser to disengage the filter from the cava wall. The filter was removed but 3 struts were left behind. We then used an endobronchial grasper and tour guide sheath to grasp each of the filter struts and remove them. (Figure B) The last strut appeared to be completely outside of the cava and was not retrievable. After completion arteriogram and venogram confirming no vessel injury with extravasation, the procedure was completed.
Results: We removed the malpositioned IVC filter along with all the IVC filter struts except for one strut that was completely outside of the IVC wall. This was the strut that extended to the lumbar spine. Patient tolerated the procedure well with no complications.
Conclusions: Laser assisted filter retrieval has been proven to be a safe and effective technique to remove embedded IVC filter refractory to high-force retrieval. However, there are cases that may require additional techniques where the filter and/or filter struts are penetrating the surrounding tissue. In our case, we utilized a combination of laser assisted techniques as well as endobronchial graspers for this case of complex IVC filter retrieval which is safe and effective in selected cases.
