CIO 2022-5 Evaluation of a Single-Institution Inferior Vena Cava Filter Retrieval Program

Purpose: Retrievable inferior vena cava (IVC) filters, if not removed, can be associated with increased mortality rates and complications. The goal of this study is to evaluate the outcomes of our filter retrieval program and identify opportunities for improvement.

Materials and Methods: This is a retrospective review of patients who had IVC filter placement between January 2019 and May 2021, including demographics, indication for filter placement, anticoagulation status, follow-up, preretrieval imaging, filter-related complications, retrieval technique, and retrieval-related complications.

Results: A total of 208 (46% male, 54% female; mean age, 58.6 [21–90] years) patients received IVC filters Sixty-five of 208 (31.3%) patients returned for follow-up. Sixty-nine of 208 (33.2%) patients were deemed safe for filter removal. Sixty-five of 69 (94.2%) had attempted filter retrieval at our institution, of which 64 of 65 (98.4%) retrievals were successful. Of the remaining 4 of 69, 3 had filter removals at outside hospitals, and 1 had an insurance denial. A total of 143 patients did not return for follow-up for the following reasons: 51 of 143 (35.6%) died within 3 months after filter placement, 14 of 143 (9.7%) were deemed permanent placements, 7 of 143 (4.9%) followed up with an outside hospital, 11 of 143 (7.7%) did not respond to follow-up, and 49 of 143 (34.3%) had no documented follow-up attempt. The mean interval between filter placement and first follow-up in clinic was 128.58 (12–768) days. Indications included history of venous thromboembolism (VTE) or VTE prophylaxis (95.3%), hypercoagulable state (3.3%), and contraindication to anticoagulation (1.4%). Seventy-one of 208 (34%) patients were under anticoagulation at the time of filter placement. Retrieval technique used were 79.7% with snare, 12.5% with forceps, 6.3% with the “hangman technique,” and 1.6% with the “realignment technique.” There were no complications during filter removals.

Conclusions: Only 31.3% of patients who underwent IVC filter placement returned to the clinic for evaluation of possible removal. IVC filter removal had high success and low complication rates. The “snare technique” was the most frequently used. A total of 28.8% of patients had no documented follow-up attempts or did not respond when contacted. Despite an active follow-up policy as well as patient and referring physician education, a considerable proportion of patients did not have appropriate follow-up.