How is an IVC Filter Removed?

The process of removing an IVC filter begins with a clinical consultation with an interventional radiologist who specializes in IVC filter removal. A number of factors are reviewed including the reason for IVC filter placement, currently blood thinner medication, the type of filter placed (if known), the dwell time of the IVC filter, and other pertinent aspects of the medical history. This is important to ensure that there is no ongoing need for the IVC filter and to evaluate the likelihood of successful retrieval.

In patients deemed eligible, the IVC filter may be removed in a fashion that mimics filter placement. Retrievable filters have a hook at one or both ends and a collapsible design. Through a small incision just above the clavicle, the venous system is accessed and a looped wire is used to grab the hook – this wire appears similar to a small lasso. Once the hook is secured, a hollow plastic tube called a vascular sheath is advanced over the IVC filter which collapses inside the sheath. The IVC filter and sheath are removed and a small bandage is applied to the incision.

In a certain proportion of patients, this conventional technique fails to successfully remove the IVC filter. Conventional methods typically fail as a result of tissue growth around the hook of the IVC filter, the body’s natural response to a foreign object. When this occurs, a number of “advanced techniques” can be used to secure the filter including various wires and catheters, and small grasping forceps. Forceps are particularly useful, and have been associated with high rates of retrieval success. This is detailed in a manuscript published in the Journal of Vascular and Interventional Radiology: http://www.jvir.org/article/S1051-0443(16)30025-2/abstract.

Procedural time for IVC filter removal is rarely greater than 1 hour, and the majority that can be removed with conventional techniques take less than 15 minutes. Procedures may be performed under either sedation or general anesthesia depending on the type of filter, medical comorbidities and patient preference. Patients typically must fast at least 6 hours prior to the procedure and are observed for 2 hours after successful IVC filter removal.

Figure 2 – Artist rendition of a filter retrieval. From http://circinterventions.ahajournals.org/content/6/5/560