PMC9684660_01
(A) The attachment of the Celect filter retrieval hook to the wall of the inferior vena cava, the surrounding proliferative tissue, and a broken pedicle. (B) The shape of the pigtail catheter after the removal of the tip. (C) Modified loop-snare technique.
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F1
Angiography via the right common femoral venous access showed that no thrombosis was found in the inferior vena cava, and that it was patent; it also showed that the main pedicle of the Celect filter was broken, the filter was obliquely attached to the retraction hook, and proliferative tissue surrounded the hook (Figure 1A). Next, part of the tip (Figure 1B) of the PIG catheter (Cordis; 4F, 100 cm) was cut, and a hydrophilic metal guidewire (Terumo angled, 260 cm) was used to increase the support force of the catheter. Based on a modified loop-snare technique (Figure 1C), the catheter was rotated to be guided into the gap between the filter and the inferior vena cava wall, and the guidewire was advanced to free its end to be snared and externalized.
(A) Cutting the proliferative tissue surrounding the retraction hook and bringing the hook back into the cavity. (B) The filter was captured by the snare, but one broken pedicle remained in the inferior vena cava. (C) Successful capture of the fractured pedicle using biopsy forceps.
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F2
A wire loop was formed across the proliferative tissue, and the counteracting forces of the guidewire and the retrieval sheath were used to destroy the proliferative tissue surrounding the retraction hook (Figure 2A), following which the filter could re-enter the inferior vena cava. Although the snared guidewire captured the retraction hook and retrieved the filter, it failed to capture the broken pedicle, which could not be retrieved simultaneously (Figure 2B). The filter retrieval set and biopsy forceps were introduced via the right common femoral venous access, and the broken pedicle was successfully captured (Figure 2C).
(A) The fractured pedicle at a vertical angle to the retrieval sheath and failure of removal. (B) The biopsy forceps and the retrieval sheath were pulled toward the distal end to coaxial lines and the broken pedicle was successfully removed. (C) The inferior vena cava was unobstructed, without spillage of the contrast agent.
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F3
However, the pedicle was at a vertical angle to the retrieval sheath and failed to enter it (Figure 3A). The broken pedicle was entered into the retrieval sheath (Figure 3B) and was removed. Subsequent angiography showed that the inferior vena cava became patent, with no spillage or residual contrast agent, and the filter was therefore completely retrieved (Figure 3C).