Modified Sling Technique for Difficult Filter Retrieval

Caval filters are placed in the inferior vena cava (IVC) to prevent pulmonary thromboembolism in patients with deep vein thrombosis. If there is no indication for thrombo-embolic risk prevention, the filter can be removed to reduce potential filter-related complications. Advanced endovascular techniques are frequently used to retrieve IVC filters. We describe an alternative filter-removal technique for use when standard techniques are not practicable. In our method, the filter hook is embedded within the IVC wall. To retrieve it, a long introducer is inserted; a guidewire and the "loop snare" retrieval system are then advanced through it with a coaxial system and positioned below the filter at the level of the common iliac vein confluence. The guidewire is then passed through the loop, creating a "sling" around the filter which allows the application of traction from the bottom upwards, releasing the hook from the wall. The loop is then held under tension with the filter aligned in the IVC lumen, and the introducer is advanced distally to completely cover the filter, allowing complete retrieval of the filter without damaging the vessel walls. This modified Sling technique is a safe and feasible method for complicated IVC filter retrieval.

An Alternative Loop Snare Technique with Many Loops Using a Simple Guide-Wire for Removal of a Double J Stent: A Case Series

Background: Removal of a double J (DJ) stent has been conventionally performed with conventional snare wires, tissue forceps, or stone baskets under fluoroscopic guidance. However, if the lumen is collapsed, is very wide, or if the tip of the DJ stent is lodged in the bladder wall, the procedure becomes difficult. Patients and Methods: We retrospectively reviewed four patients who had undergone retrieval or replacement of their DJ stents by interventional radiologists with an alternative loop snare technique using a guide-wire after conventional attempts using a snare catheter had failed. Results: Five DJ stents were completely removed without any complications. Conclusion: The loop snare technique using a guide-wire could be an alternative and inexpensive approach for difficult DJ stent removal.

Retrieval of Inferior Vena Cava Filters Temporarily Placed in a Suprarenal Position: A Review of 13 Patients

Purpose: To evaluate the safety and efficacy of retrieval of inferior vena cava filters (IVCF) temporarily placed in a suprarenal position. Methods: Retrieval of IVCF placed in a suprarenal position was performed in 13 patients (5 men and 8 women; mean age: 45.1 ± 13.8 years) between July 2006 and May 2018 using either a loop snare technique or endobronchial forceps. Electronic medical records were reviewed for patient demographics and procedural information. Results: Inferior vena cava filters retrieved included Option Elite (n = 9, 69%) and Günther Tulip (n = 4, 31%). Caval thrombosis was not detected in any patients on pre- or postretrieval cavogram. Eleven suprarenal IVCF (84%) were retrieved during the first retrieval attempt after a median indwelling time of 1.8 months (range, 0.03-12.10 months). Retrieval was initially unsuccessful in 2 (16%) patients with Option Elite filters, but both were successfully removed on second attempt using endobronchial forceps. Thirteen suprarenal IVCF (100%) were ultimately retrieved. Conclusion: Endovascular retrieval of IVCF temporarily placed in a suprarenal position is safe and efficacious.