Adam Fang, MD
University of Maryland School of Medicine
Disclosure(s): No financial relationships to disclose
To determine differences in technical success, retrieval techniques, and complications for inferior vena cava (IVC) filter retrieval in patients with closed cell vs open cell designed retrievable filters.
Materials and Methods:
A retrospective review was performed of 318 patients who underwent IVC filter retrieval at a tertiary academic medical center between 2004 and 2021. A total of 271 patients had retrievable IVC filter types recorded and were further categorized based on their design as closed cell or open cell filters. Closed cell filters with complete metal circuits (n=66) included 13 Gunther Tulip, 37 Option Elite, and 16 OptEase filters. Open-cell filters with single metal elements (n=205) included 59 Denali, 34 Eclipse, 51 G2, 6 Meridian, and 55 Celect filters. Technical success, retrieval techniques, fluoroscopy time, procedural time, radiation dose, anesthesia type, and complications were analyzed.
Technical success rates for IVC filter retrieval were lower for closed cell compared to open cell filters (90.9% [60 of 66] vs 98.0% [201 of 205]; p = 0.016). The average dwell times for closed cell and open cell filters were not statistically different (564.4 days vs 621.7 days; p = 0.45). Advanced retrieval techniques were more frequently utilized for closed cell filters compared to open cell filters (54.6% vs 29.3%; p = 0.0003). For close cell vs open cell filters, average fluoroscopy time (29.3 min vs 15.2 min; p = 0.0014) and average procedural time (83.5 min vs 57.2 min; p < 0.0001) were significantly higher for closed cell filter retrieval. However, average radiation dose during IVC filter retrieval was not statistically different between the two filter designs (3,118 mGy vs 1,569 mGy; p = 0.26). Moderate anesthesia was used for majority of closed cell and open cell filter retrievals (95.2% vs 97.1%; p = 0.90). For closed cell and open cell filter retrievals, while major complications (0% vs 1.5%; p > 0.99) did not differ between the two groups, minor complications (7.6% vs 1.5%; p = 0.02) were higher in the close cell filter retrieval group.
Closed cell filter retrieval results in lower technical success and higher minor complications rates compared to open cell filter retrieval. Due to the multiple closed cell strut design providing a scaffold for epithelialization, neointimal hyperplasia and fibrosis, close cell filters are more difficult to retrieve and frequently require the use of advanced retrieval techniques leading to significantly greater fluoroscopy and procedural time.