Endovascular Techniques In Retrieving Tilted And Adherent Inferior Vena Cava Filter

Objective: To explore the clinical experience and techniques of balloon-displacement and wire-Loop-snare technology to retrieve the tilted and adherent retrievable inferior vena cava filter(RIVCF).Methods: The data of 31 patients(15 male;mean age,57.90±16.37(range: 22-85)years)with tilted and adherent RIVCF who received endovascular removal between March 2017 and September 2020 were retrospectively analyzed in this study.The mean indwelling time of IVCFs was 54.55±124.34 days(range,7-693 days).The filter hook was shimmied away from the cava using balloon-displacement and Loop-snare technique,and all filters were successfully removed.The perioperative complications were recorded postoperatively,and the follow up of vena cava patency was also retrospectively analyzed.Results: 31 complicated IVCFs were successfully removed,including3 Denali(Bard),20 Opt Ease(Cordis),6 Celect(Cook),2 Günther Tulip(Cook).Twelve cases were successfully removed by balloon-displacement technique,while the other 19 cases were successfully retrieved by Loop-snare technique,including 6 cases with simple Loop-snare technique,9 cases with codirectional dual Loop-snare technique,4 cases with bidirectional dual Loop-snare technique.The mean operative duration was79.42±34.65(range: 35-157)minutes.The overall incidence of procedural complications was 9.68%(3/31),while no major procedure-related complications were observed.With 21.39±10.62 months(range 4-48months)follow-up,there was one patient died of brain glioma,and the patency of vena cava was 100%.Conclusion: The techniques of balloon-displacement and wire-Loop-snare can effectively remove the tilted filter and improve the recovery of complicated RIVCF caused by tilt and adherence,which are worthy of clinical application.