Answers: 1. A – Conical 2. C - 28mm (average is 23mm) 3. 15 | Figure 1

SIRRFS

Radiology

Answers:

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 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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