Retrieval of gunther tulip vena cava filter with thrombosed hook and a leg incorporated into the vena cava wall.

A Gunther tulip vena cava filter was implanted in a patient with pulmonary embolism from deep venous thrombosis. The filter became unnecessary after therapy. However, retrieval by the standard method employing a vascular sheath placed via the transjugular approach in combination with a snare device was impossible. A thrombus occupying the apical hook made it difficult to snare the hook, also one filter leg was incorporated into the inferior vena cava wall. Therefore we modified an existing method to withdraw the filter. As the first step, the filter cone was snared using the snare-over-guide wire loop technique, and the cephalad site of the filter was introduced into the sheath. Then, a 12-French sheath was advanced from the femoral vein and, using a pusher, the distal legs of the filter were pushed, which resulted the filter leg that was incorporated into the inferior vena cava wall became detached. Finally the filter was successfully retrieved.