Warren Clements1,2, Heather K Moriarty3, Eldho Paul4,5, Gerard S Goh3,6. 1. Department of Radiology, Alfred Health, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia. w.clements@alfred.org.au. 2. Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia. w.clements@alfred.org.au. 3. Department of Radiology, Alfred Health, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia. 4. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. 5. Clinical Hematology Department, Alfred Hospital, Melbourne, Australia. 6. Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
Abstract
PURPOSE: Currently, data surrounding predicting difficulty of IVC filter retrievals are heterogenous and conflicting. We aimed to identify which of many variables associated with IVC filters is a risk for procedural difficulty. MATERIALS AND METHODS: This study retrospectively reviewed 6 years of IVC filter retrievals at a tertiary center identifying 356 consecutive retrievals. A difficult retrieval was defined as any case where the fluoroscopy time exceeded 7 min, an advanced technique was required, the retrieval attempt failed and required an additional attempt or was left permanent, or there was major complication such as IVC filter fracture/migration/vessel injury. RESULTS: There were 105 filter retrievals defined as difficult (29.5%). Univariate analysis showed significantly increased risk for retrievals with an embedded top. Multivariate analysis assessed the association between dwell time, tilt, age, non-hooked filters, leg penetration and difficult retrieval. This showed a significant increase in the difficulty of retrieval for filters tilted between 5° and 15° (odds ratio 2.38, p < 0.001), for filters tilted more than 15° (odds ratio 7.91, p < 0.001), and dwell time greater than 6 months (odds ratio 2.06, p = 0.033). No significant increase in difficulty was seen with filters with a dwell time of less than 6 months, leg penetration, non-hooked filters, or with increasing patient age. CONCLUSIONS: Identifying these risks in patients in advance of the procedure allows appropriate planning and improved workflow efficiency.
PURPOSE: Currently, data surrounding predicting difficulty of IVC filter retrievals are heterogenous and conflicting. We aimed to identify which of many variables associated with IVC filters is a risk for procedural difficulty. MATERIALS AND METHODS: This study retrospectively reviewed 6 years of IVC filter retrievals at a tertiary center identifying 356 consecutive retrievals. A difficult retrieval was defined as any case where the fluoroscopy time exceeded 7 min, an advanced technique was required, the retrieval attempt failed and required an additional attempt or was left permanent, or there was major complication such as IVC filter fracture/migration/vessel injury. RESULTS: There were 105 filter retrievals defined as difficult (29.5%). Univariate analysis showed significantly increased risk for retrievals with an embedded top. Multivariate analysis assessed the association between dwell time, tilt, age, non-hooked filters, leg penetration and difficult retrieval. This showed a significant increase in the difficulty of retrieval for filters tilted between 5° and 15° (odds ratio 2.38, p < 0.001), for filters tilted more than 15° (odds ratio 7.91, p < 0.001), and dwell time greater than 6 months (odds ratio 2.06, p = 0.033). No significant increase in difficulty was seen with filters with a dwell time of less than 6 months, leg penetration, non-hooked filters, or with increasing patient age. CONCLUSIONS: Identifying these risks in patients in advance of the procedure allows appropriate planning and improved workflow efficiency.