Endobronchial forceps effective in retrieval of tip-embedded inferior vena cava filters

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When retrievable inferior vena cava filters were approved for use in the USA in 2003 to prevent pulmonary embolism among patients unable to receive the standard blood thinner treatment, many experts anticipated most of them would be removed when no longer needed and inferior vena cava filter complications would decrease.

Instead, the number of filters placed has more than doubled in the last 10 years, and by some estimates, less than half of these retrievable devices are actually removed each year. Leaving the devices in place risks filter fracture or symptoms from penetration of filter components outside of the vein into adjacent structures, increased risk of new blood clots in the legs, and other complications.

Now, a Penn Medicine study published in the journal Radiology confirms that an endobronchial forceps technique the research group developed is a safe and highly effective option for many patients seeking inferior vena cava filter removal.

The Penn Medicine team studied 114 adult patients (77 women and 37 men) who visited the Hospital of the University of Pennsylvania for removal of a tip-embedded retrievable inferior vena cava filter between January 2005 and April 2014. All patients who underwent retrieval of a filter were evaluated by an interventional radiology attending physician and underwent computed tomographic venography of the abdomen and pelvis.

The researchers say the endobronchial forceps technique helps fill a void where standard procedures fail. The most common reason for a failed filter retrieval is tilting of the filter, with the tip of the filter becoming embedded in the wall of the inferior vena cava. When this occurs, a snare or cone device cannot be placed over the tip of the filter, and standard techniques for removal fail. The newer technique allows these filters to be removed.

“Endobronchial forceps was successful in 97% of patients who presented to our institution with tip-embedded inferior vena cava filters,” said lead author S William Stavropoulos, professor of Radiology. “This method offers many patients a new, safe option for retrievable filter removal when standard methods are not possible. This in turn allows more patients to have their filter successfully removed instead of leaving them in place permanently.”

Penn interventional radiologists found a particularly strong need for the new technique after standard methods with snare or retrieval cones were not successful in removing filters whose tips were embedded in the wall of the inferior vena cava.

The increasing number of retrievable filters that go unremoved each year and related complications led the US Food and Drug Administration to release 2010 and 2014 safety alerts urging physicians who place the filters to be responsible for their patient’s ongoing care after the procedure and remove the filters as soon as they are no longer needed.

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