The patient had a previously placed IVC filter with many ant | Figure 1

SIRRFS

Radiology

Case Details

The patient had a previously placed IVC filter with many anterior limbs with possible extension through the IVC and into the duodenum with ascending colonic wall thickening and surrounding fat stranding raising concern for occult traumatic injury related to IVC filter limbs. The treatment options included endoscopic to verify bowel penetration with endovascular versus surgical removal. Since the patient was hemodynamically stable, a conservative approach was used. Initial attempts using loop snare technique, endobronchial forceps, and a goose neck snare were unsuccessful. Ultimately, obtaining jugular and femoral access and flipping the IVC filter resulted in successful removal. Anyone else have success using the flipping technique for IVC filter removal?

Case courtesy of Drs. Cosette Stahl and Hamed Aryafar from the UCSD Medical Center - Dept of Radiology.

Related Cases

• Diagnosis: Chronically embedded IVC filter and chronic left iliofemoral venous occlusion. 55-year-old man with a chronically embedded OptEase IVC filter and left iliofemoral venous occlusion now status post successful IVC filter removal utilizing wire loop and laser retrieval methods and venous recanalization, plasty, and stent placement requiring a novel technique for attaining through and through RIJV- LCFV access. (Courtesy of Dr. Erin Moody from Stanford University)

• Clinical Notes: 1. A – Conical 2. C - 28mm (average is 23mm) 3. 15 degrees
  Figure 1 & 2: Inferior venocavogram in the AP and lateral projections was performed to confirm patency of the inferior vena and to assess for the presence of filter thrombus.
  Figure 3: Multiple unsuccessful attempts were made to snare the filter hook with an Amplatz GooseNeck Snare Kit.
  Figure 4: Rigid endobronchial forceps were also unsuccessful. Next, the decision was made to attempt the “Hangman” technique for IVC filter retrieval.
  The 11-french sheath was exchanged over the super-stiff guidewire for a 14-french 10 cm sheath. A 5-french Omni Flush catheter was advanced through the sheath and used to guide an 0.035” guidewire around the horizontally oriented filter struts. An Amplatz GooseNeck Snare was then advanced through the 14-french sheath.
  The Omni Flush catheter was removed over the guidewire. The glidewire tip was then snared with the GooseNeck Snare and pulled externally through the sheath. At this point, the glidewire encircled the filter struts with both ends of the glidewire extending through the sheath and outside of the patient.
  Figure 5: With the glidewire encircling the filter struts, both ends of the glidewire were simultaneously pulled while forward pressure was applied on the sheath. The filter then collapsed into the 14-french sheath.
  The filter was removed through the sheath in its entirety. An inferior venocavogram subsequently demonstrated no evidence of caval injury. The patient tolerated the procedure well without any apparent complication. He remained admitted until the following day at which time he was symptom-free.

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