Excimer Laser Sheath–Assisted Retrieval of “Closed‐Cell” Design Inferior Vena Cava Filters

Abstract

Background Numerous reports have shown that inferior vena cava filters are associated with clinically significant adverse events. Complicating factors, such as caval incorporation, may lead to technical challenges at retrieval. The use of advanced techniques including the laser sheath have increased technical success rates; however, the data are limited on which filter types necessitate and benefit from its use. Methods and Results From October 2011 to September 2019, patients with inferior vena cava filter dwell times >6 months or with prior failed retrievals were considered for laser sheath–assisted retrieval. Standard and nonlaser advanced retrieval techniques were attempted first; if the filter could not be safely or successfully detached from the caval wall using these techniques, the laser sheath was used. Technical success, filter type, necessity for laser sheath application based on “open” versus “closed‐cell” filter design, dwell times, and adverse events were evaluated. A total of 441 patients (216 men; mean age, 54 years) were encountered. Mean dwell times for all filters was 56.6 months, 54.4 among closed‐cell filters and 58.5 among open‐cell filters ( P =0.63). Technical success of retrieval was 98%, with the laser sheath required in 143 cases (40%). Successful retrieval of closed‐cell filters required laser sheath assistance in 60% of cases as compared with 7% of open‐cell filters (odds ratio, 20.1; P <0.01). In closed‐cell inferior vena cava filters, dwell time was significantly associated with need for laser, requiring it in 64% of retrievals with dwell times >6 months ( P =0.01). One major adverse event occurred among laser sheath retrievals when a patient required a 2‐day inpatient admission for a femoral access site hemorrhage. Conclusions Closed‐cell filters may necessitate the use of the laser sheath for higher rates of successful and safe retrieval.