Advanced retrieval technique using pacemaker lead extraction methods for a long-term implanted inferior vena cava filter with caval penetration of the pancreas

Abstract

Inferior vena cava (IVC) filters are sometimes implanted in patients with deep vein thrombosis (DVT) to prevent pulmonary embolism (PE). Long-term filter placement is associated with various complications and retrieval failure using conventional methods. We describe a novel method for retrieval of long-term implanted IVC filters. A 41-year-old woman was diagnosed with left common iliac DVT. A temporary IVC filter was implanted to prevent life-threatening PE in parallel with anticoagulation therapy, followed by the long-term retrievable IVC filter (Denali, Bard Medical, Georgia, IN, USA). After successful anticoagulation therapy, the retrieval of the Denali by conventional methods failed due to adhesion to the vessel wall. We decided to remove the Denali using pacemaker lead extraction methods. Twenty months after the Denali implantation, extraction was performed under general anesthesia. A snare catheter (Lassos, Osypka, Berlin, Germany) was used to capture the proximal hook. The severe adhesions around the anchors were carefully dissected using a mechanical sheath (Byrd Dilator Sheaths, Cook Medical, Bloomington, IN, USA). The Denali was extracted using the counter-traction technique. The post-operative course was uneventful. This technique may be useful for uneventful removal of long-term implanted IVC filters, potentially avoiding open surgery. Additional experience is needed to overcome the limitation of a single case report.

Learning objective

Inferior vena cava (IVC) filters are sometimes used to reduce the risk of life-threatening pulmonary embolism. Long-term implanted IVC filters are associated with filter-related complications and can be difficult to remove by conventional methods due to adhesion around the filter. We describe a novel IVC filter retrieval technique using pacemaker lead extraction tools that has the potential to avoid highly invasive open surgery.