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BACKGROUND:
With an increasing utilization of inferior vena cava filters there is an associated higher incidence of filter thrombosis. The need to retrieve these filters is evident. We present a novel way to remove IVC filters using a homemade snare.
METHODS:
An 0.014 semi-stiff wire is utilized. The wire is doubled and a loop is formed. At 2 cm proximal to the loop the long end of the wire is bent forming an angle . The loop is brought out through an 8 french sheath. The shorter end of the wire is pulled and the longer end of the wire is advanced creating a right angle semi-stiff loop that varies in size with wire manipulation. The sheath along with the loop are advanced over the filter. Because of the right angle of the loop and stiffness of the wire the snare encompasses the entire lumen of the vena cava and capturing the filter hook becomes effortless. Once the loop sits on the filter head the loop is tightened and filter hook is snared. The sheath is then advanced over the filter until the filter is constrained. The filter is then pulled out through the sheath.
RESULTS:
A total of 14 consecutive filters were retrieved over a course of 8 month time. All filters were retrievable type containing a hook at the head of the filter. The average time of filter implementation was 2.2 months, the shortest 5 weeks and longest 13 months. All were retrieved using our homemade snare technique and a 45cm length 8 French Terumo destination sheath. 8 filters were aligned in a straight position the remaining 4 had a tilt but no greater than 45 degrees. A pre and post procedure veno-cava gram was preformed in all patients revealed no thrombus in the vena cava or the filter and no caval injury. All filters hook were easily snared on the very first attempt. The cost of an 0.14 wire is $100 compares to the cheapest available snare $250. No complications occurred in the 14 patients.
CONCLUSIONS:
A large number of IVC filters are placed annually with low complication rates however physicians should be aware of the devastating outcomes and high mortality rates associated with IVC filter thrombosis. Every effort should be made to retrieve filters once the risk of pulmonary embolism is eliminated. Our novel technique to retrieve filters is efficient, safe and cost effective.