Indications

• No remaining contraindication to anticoagulation.

• Permanent filter not necessary.

• Sufficiently low risk of PE and no expected return to high risk.

• Life-expectancy warrants removal.

• Filter can be safely removed

Contraindications

• Essentially the same as for placement. Significant thrombosis within or upstream of the filter could pose serious risk of PE.

• Very few absolute contraindications, and the decision often comes down to the risk of causing a more serious complication than the pt would have just leaving the filter in place.

Imaging Review

• Review CT and Doppler imaging:

  • • Filter location

    • IVC and access site patency

    • Absence of acute DVT

• Filters that have been in place longer than a certain time period (depends on the attending) will require recent CT venography of the abdomen/pelvis to more completely evaluate the anatomy.

• Single shot fluorogram at the start of the procedure helps document structure of filter prior to manipulation.

Tips for Workup

• Access: Typically IJ for most filters; femoral for OptEase; more complex retrievals may require sheaths above and below

• Anesthesia: GA may be preferred for retrievals that are anticipated to be longer and more complex (higher risk for hemodynamic instability)

• Consent:

  • • Filter migration / fracture / penetration, vena cava laceration à hemorrhage or thrombosis, PE, arrhythmia, air embolism, access site thrombosis/hemorrhage/infection.