What is a Günther Tulip inferior vena cava (IVC) filter?

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

The Günther Tulip filter was approved by the FDA in 2003. [62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73] This filter is made from nonferromagnetic Conichrome, and it is conical in design with a hook at the apex for retrieval. It has 4 legs of 44 mm with barbed hooks for anchoring; 4 additional wires wrap around the primary legs to form a tulip-petal conical structure with a total of 12 wires for clot trapping. The maximum diameter is 30 mm, and its maximum height is 50 mm. The introducer system is of 8.5F ID, and different packages are available for femoral or jugular approaches. The retrieval system is of 7F ID (11F OD for the sheath) and is employed via a jugular approach only.

The direction of the hook is a factor that influences the rate of success during retrieval of the Günther Tulip filter. Millward et al recommend orientating the hook toward the lumen of the IVC, especially if filter tilting is anticipated. These authors also advocate anticoagulation for 24-48 hours before retrieval.

A venacavogram must be performed before retrieval to assess the amount of trapped clot. More than 25% of clot trapped in the cone is a contraindication to retrieval. The filter is also not to be retrieved in cases of continued requirement of a filter or if it is technically not possible to be retrieved because of trapped thrombus, adherence to the IVC wall, or filter tilt. The reported total caval occlusion rates are 0-6%.

The recommended retrieval time is in the first 12 days, but various authors have prolonged the time to retrieval with or without repositioning the filter for up to 3-4 weeks, or even longer. [74]

In 2009, Smouse et al reported on a multicenter experience of 554 patients. Filter retrieval was successful in 248 (90.2%) of 275 patients. [74] The mean indwell time was 58.9 days (range, 3-494 d). Their analysis showed a probability of successful retrieval greater than 94% at 12 weeks and greater than 67% at 26 weeks. [74] Excessive filter tilt and tissue in-growth are main causes of failed retrieval.

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