What are retrievable inferior vena cava (IVC) filters?

Updated: Oct 31, 2020
  • Author: Gary P Siskin, MD; Chief Editor: Kyung J Cho, MD, FACR, FSIR  more...
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Answer

Answer

Over the past decade, several new filters have been approved as retrievable filters. These devices are sometimes referred to as optional filters, because they can be retrieved after a period following placement or can be left in the patient as a permanent device. [50, 51, 52, 53, 54, 55, 56, 57, 58, 59]

Retrievable/optional IVC filters include the following:

  • Günther Tulip filter

  • Recovery filter

  • Recovery G2/G2 and G2 X filters

  • OptEase filter

  • Celect filter

  • ALN filter

  • Option filter

The SafeFlo filter is available in Europe as an optional filter, but it is currently approved only as a permanent filter in the United States.

There are also temporary filters that require removal, such as the Tempo filter II. Convertible filters are optional filters that the filtration property can be altered with a second procedure. Such an example is the VenaTech Convertible filter, which becomes a stent after conversion. These are currently not available in the United States.

Some patients need a filter to protect from PE for only a short period. Decousus et al suggested that IVC filters provide only short-term protection. [60] Significant reduction of the PE rate was reported at day 12, but no difference was reported at 2 years when compared with anticoagulation therapy. After over 8 years of follow-up, the incidence of postthrombotic syndrome and of DVT were higher in the filter group, and the PE rate was lower. [60] In the same follow-up study by the Prevention du Risque d’Embolie Pulmonaire par Interruption Cave, a cumulative incidence of symptomatic IVC thrombosis of 13% after 8 years was noted [60] ; by contrast, Crochet et al reported a higher rate of 33% caval thrombosis in a 9-year follow-up of the Vena Tech LGM filter. [35]

The Society of Interventional Radiology guidelines for the use of retrievable filters recommends that "the decision to use an optional filter rather than a permanent filter should be based on the anticipated required duration of protection against clinically significant PE and/or risk of pharmacologic therapy." [54]

When the indication for caval filtration is no longer present in a patient or the risk of PE is acceptably low because of a change in clinical status or because prophylactic therapy was successful, these patients can be considered for filter retrieval. Patients should be fully evaluated by clinical status, laboratory findings, and imaging before the attempted retrieval.

When there is a need for continuous caval filtration, optional filters can be left in situ as a permanent device. In some cases, these filters are not removed or their retrieval may be deferred for various reasons, such as poor clinical status, short lifespan, significant amount of clot trapped within the filter, IVC thrombosis, or technical difficulties that prevent safe retrieval.

In younger patients who have a longer life expectancy, use of a retrievable filter is a more valid option for physicians and patients than the use of a permanent device. These optional filters have gained popularity over the years. More and more of these devices are being left as permanent filters. [61] Although the percentage of successful retrieval varies, some series quote retrieval rates of up to 100% technical success for the selected patients.


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