Placement and Retrieval of Inferior Vena Cava Filters. A Case-Based Approach

Current Data and Trends on Inferior Vena Cava Filter Placement and Retrieval.- IVC Filter Placement: Accepted and Relative Indications.- Filter Placement: Anatomical Evaluation and Approach to Variant Anatomy.- IVC Filter Retrieval: Routine Approach.- Filter Strut Penetration: Does it Matter?.- Retrieval of Filters with Embedded Apices.- Filter Strut Incorporation: Tools for Success and Improved Procedural Safety.- Approaches to Fractured Filters.- Filter Migration and Misplacement.- Management of the Acute Thrombus-Bearing IVC Filter.- Permanent Inferior Vena Cava Filter Retrieval: Special Considerations.- Management of Filter-Related Chronic Iliocaval Occlusion.

This book addresses placement and retrieval of inferior vena cava (IVC) filters. Until 2010, utilization of IVC filters had been increasing since their introduction in 1967. Studies in the early 2000's, however, identified that prolonged caval interruption with IVC filters were fraught with complications including filter fracture, migration, and caval thrombosis. This subsequently led the FDA to issue an advisory recommending judicious placement and timely retrieval of IVC filters by treating physicians. This safety advisory ultimately created a heightened awareness by medical professionals and the general public regarding the negative consequences surrounding long-term caval filtration. Subsequently, IVC filter placements decreased nationally while retrievals conversely increased in the post-FDA advisory era. During this same time period, interest in complex IVC filter retrieval also increased as a method to manage patients identified to have or be at risk for complications secondary to prolonged filter implantation.

Given these established trends and interest surrounding advanced techniques in IVC filter retrieval, this book addresses these topics in a reader-friendly, case-based format. Chapters focus particularly around the recognition and management of filter-related complications. Additionally, advanced techniques employed by experienced operators for complex filter retrieval are also discussed. For completeness, the book also includes a review of indications and appropriate methods for IVC filter placement.

This book is unique in that, at present, descriptions of complications and advanced techniques utilized for complicated IVC filter removal consist mainly of case reports and case series scattered throughout the literature. This publication serves to compile these sources into a single comprehensive entity for physicians treating patients with IVC filters. Chapters are organized to begin with a few introductory paragraphs highlighting the relevant literature (and providing references for in-depth reading) followed by several cases demonstrating tips, tricks, and procedural pitfalls. When possible, each case will include a step-by-step description of the technique being described.

This is an ideal guide for interventional radiologists, interventional cardiologists, and vascular surgeons that perform or are interested in performing filter retrieval beyond standard techniques.

Kush Desai, MD is Assistant Professor of Radiology, Surgery, and Medicine, Division of Interventional Radiology, Northwestern University Feinberg School of Medicine.

Osman Ahmed, MD is Assistant Professor in the Section of Interventional Radiology, Department of Radiology at University of Chicago Medicine.

Thuong Van Ha, MD is Professor in the Section of Interventional Radiology, Department of Radiology at University of Chicago Medicine.