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
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.
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.
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.