Author: Dr. Aravinda Nanjundappa

Institution: Director, Peripheral Interventions, Cleveland Clinic, USA

Summary

This presentation introduces the latest techniques for removing complex inferior vena cava (IVC) filters, focusing on laser-assisted and surgical approaches, particularly in cases involving filter tilt or thrombus formation. Through several clinical case studies, the author analyzes different strategies for filter removal, with a special emphasis on the successful application of laser technology in long-term filter implants. The study shows that laser-assisted technology significantly increases the success rate of filter removal, especially in challenging cases where previous removal attempts have failed.

Introduction

The concept of the IVC filter was first proposed by Armond Trosseau in 1868 for the prevention of deep vein thrombosis (DVT). Modern IVC filters are primarily used for DVT and pulmonary embolism (PE) patients, particularly those who cannot undergo anticoagulation therapy. In rare cases, IVC filters are used when anticoagulation fails or in patients with left heart dysfunction and right heart enlargement.

Common Issues in Filter Removal

• Filter Tilt: Some filters may tilt, complicating the removal process. Techniques such as the “Hangman” Terumo wire and SOS catheter can assist in these cases.

• Long-term Filter Implants: Filters may become difficult to remove due to thrombus formation or calcification. Laser technology can help break down fibrous tissue, preventing direct traction injuries to the IVC.

Case Studies

• Case 1: A 33-year-old patient had an IVC filter implanted for DVT, later experiencing leg swelling and fatigue. The filter was successfully removed using a combination of laser assistance and a snare technique.

• Case 2: A patient with an IVC filter implanted for over 17 years had a complete occlusion of the IVC and iliac veins on pre-operative CT. Laser technology was successfully used to break up the filter, and the occluded veins were repaired with stents and balloon dilation.

Laser-Assisted Filter Removal Techniques

Laser technology dissolves fibrous tissue around the filter, allowing for safe removal without damaging the IVC. The advantages of laser removal include:

• Reduced Force Usage: Laser-assisted removal requires less force compared to traditional methods, reducing the risk of IVC perforation and bleeding.

• Higher Success Rate: In a study of 249 patients, the success rate of laser-assisted filter removal was 99.2%, significantly higher than non-laser methods.

Conclusion

1. Laser-assisted techniques significantly improve the success rate of complex IVC filter removal, particularly in cases of long-term implants and filter tilt.

2. Laser technology provides a safe and effective means of thrombus and fibrous tissue removal, reducing the risk of IVC injury and surgical complications.

3. Continued research and technological advancements will further optimize complex filter removal techniques, improving patient outcomes.

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