PMC10246343_01
A 72-year-old man with history of gastric adenocarcinoma, peritoneal metastases and pulmonary embolism had temporary inferior vena cava filter inserted before radical gastrectomy with difficult filter retrieval which was finally successfully retrieved with loop-snare technique after dissecting the embedded filter hook with the 16Fr sheath, with two loop-wires (arrowheads) and finally snared with 4Fr Goose Neck snare (arrow), as shown in this fluoroscopic image.
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F1
Hook of the IVC filter was then snared with 4Fr 10 mm Amplatz Goose Neck Snare (Medtronic) and filter was successfully retrieved within the 16Fr sheath, as shown in [Figure 1].
PMC10246343_02
A 50-year-old lady presented with left lower limb deep vein thrombosis with large fibroid had inferior vena cava (IVC) filter inserted preoperatively. Retrievable Celect Platinum IVC filter was placed at the suprarenal level due to limited landing zone. Attempted IVC filter retrieval 4 weeks later failed with venogram showing marked lateral tilting of the IVC filter in supra-renal location of IVC, with the hook likely embedded in the wall of the IVC.
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F2
Attempted IVC filter retrieval 4 weeks later failed with venogram showing marked lateral tilting of the IVC filter in suprarenal location of IVC, with the hook likely embedded in the wall of the IVC, as shown in [Figure 2], retrieval failed despite multiple attempts with the IVC filter retrieval set (Cook Medical, Bloomington, Ind.).
PMC10246343_03
A 42-year-old lady presented with left lower limb deep vein thrombosis with large fibroid had retrievable Celect Platinum inferior vena cava (IVC) filter inserted preoperatively. Attempted IVC filter retrieval with filter re-alignment done using 12 x 40 mm Mustang angioplasty balloon (arrow) which showed no significant improvement and retrieval was failed.
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F3
Attempted IVC filter retrieval 3 weeks later failed despite multiple attempts with IVC filter retrieval set (Cook Medical, Bloomington, Ind.), Goose Neck Snare (Medtronic), and 7Fr 17-30 mm EN Snare (Merit Medical), attempted filter realignment was done with 12 x 40 mm Mustang angioplasty balloon (Boston Scientific) without significant improvement, as shown in [Figure 3].
Complimentary computed tomography showed inferior vena cava penetration by filter with embedment of filter hook and some primary struts (arrow), same patient as in Figure 3.
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F4
Complimentary CT showed IVC penetration by filter with embedment of filter hook and some primary struts, as shown in [Figure 4].
Another attempt a few days later also failed, same patient as in Figure 3. Loop-wire (arrow) was made with 260 cm Terumo J guidewire, 5Fr SHK catheter and 7Fr 17-30 mm EN Snare and tension was applied to try to realign the filter, but embedded filter hook by fibrous cap cannot be dissected out with double sheath technique, as shown in this fluoroscopic image.
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F5
Terumo J guidewire, 5Fr SHK catheter (Cook Medical, Bloomington, Ind.), and 7Fr 17-30 mm EN Snare (Merit Medical) and tension applied to try to realign the filter, the embedded filter hook by fibrous cap cannot be dissected out with double sheath technique, as shown in [Figure 5]. The loop-wire was released and another attempt to re-direct the loop-wire on the fibrous cap over the right side of IVC wall by 8.5Fr Destino REACH steerable sheath (Oscor) and Terumo J guidewire was done, another attempted retrieval with combination of loop-snare technique and double sheath technique with loop-wire at another site was also unsuccessful.