Evolving Paradigms in Complex IVC Filter Retrieval: Navigating Beyond Conventional Techniques
Creators: name: Stibbs, Peter
name: Dewart, Steven
name: White, James
name: Lewis, Michael
name: Chapman, Dory
Publisher: name: Zenodo
Year: 2024

description: The domain of inferior vena cava (IVC) filter retrieval iscurrently experiencing a paradigmatic shift, precipitated by significant advancements in procedural techniques and the advent of specialized retrieval instruments. This evolution has catalyzed the necessity for a critical reassessment of the criteria defining "complex" retrievals within thecontext of contemporary vascular interventional radiology. Historically, the procedural framework for IVC filter retrievals has been predominantly circumscribed to conventional methodologies, such as the snare and sheath or loop and snare techniques, which have been delineated as the sole recommended practices within the manufacturers’ Instructions for Use (IFU). However, the advent of more sophisticated and versatile techniques heralds a departure from this traditionalist perspective, challenging the extant paradigms and proposing a redefinition of complexity in IVC filter retrieval.This article examines the trajectory of evolution in IVCfilter retrieval practices, with a focused discourse on the integration and efficacy of advanced methodologies that have recently emerged in the field. Among these innovative techniques are the loop-over-snare method, which leverages a loop mechanism to secure and retrieve the filter more effectively, especially in scenarios where conventional snaring proves ineffectual; theballoon inflation technique, utilizing a balloon catheter to facilitate the repositioning and subsequent retrieval of the filter; and the hangman technique, whichemploys a noose-like mechanism for the retrieval of filters situated in anatomically challenging positions or those that have become significantly endothelialized. Furthermore, this article delves into the utilization of endobronchial forceps for direct mechanical engagement and retrieval of IVC filters, a technique borrowed from thoracic surgery that has shown promising adaptability and success rates in vascular interventional radiology.Additionally, the deployment of the Phillips CAVA Clear system for the mechanical disruption of tissue in growth around the filter, thereby simplifying the retrieval process, is critically analyzed. The discourse extends to the exploration of purpose-built sheath systems, such as the Argon Medical Kodiak sheath, which are specifically designed to augment the efficacy and safety of complex retrievals. Moreover, the utilization of filter inversion techniques, facilitated by large-bore sheaths such as the 20-22 French Medtronic Sentrant or Gore Dry Seal sheaths, represents a novel approach in managing retrievals deemed infeasible through traditional methods.This review aims not only to delineate and appraise the aforementioned techniques but also to catalyze a reevaluation of what constitutes "complex" retrieval in the current landscape of IVC filter retrieval practices.By doing so, it endeavors to foster a more nuanced understanding and classification of retrieval complexities, thereby guiding the development of more effective, safer, and patient-centric proceduralstrategies. Through this scholarly endeavor, we advocate for an expanded methodological repertoire and a dynamic approach to procedural complexity, underpinned by empirical evidence and clinical pragmatism, to enhance patient outcomes in the realm of vascular interventional radiology.