In this episode of the Back Table Podcast, interventional radiologist Dr. Noor Ahmad discusses his algorithm for complex inferior vena cava (IVC) filter retrievals and reviews several cases that utilize various retrieval tools.

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SYNPOSIS

Dr. Ahmad emphasizes that most patients are referred by physicians with whom he maintains good relationships, and both specialties jointly monitor patients after IVC filters are placed. Generally, it is ideal to remove IVC filters around the 3-month mark, with filters in place for over 6 months posing a higher risk of requiring complex retrieval. For preoperative evaluation, obtaining a history of the filter type and placement date, along with CT scans (non-contrast and venogram), is crucial. Anticoagulation is typically discontinued two days prior to retrieval.

During the procedure, moderate sedation and internal jugular access are used. However, complex retrievals may necessitate general anesthesia and access through the femoral vein or dual sites. The initial device employed is usually the CloverSnare to hook and extract the IVC filter. If unsuccessful, Dr. Ahmad proceeds with techniques such as the hangman (modified loop snare), endobronchial forceps, and finally the CavaClear laser sheath. He highlights that particularly challenging cases might require collaboration with colleagues, especially when dual access is needed, possibly requiring rescheduling for general anesthesia availability. Patient safety is emphasized in these scenarios. Lastly, Dr. Ahmad presents past cases with imaging to illustrate various retrieval methods.

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TIMESTAMPS

00:00 - Introduction

03:29 - Referrals and Tracking for Filter Removal

08:49 - Working Up Complex Cases

13:19 - Patient Selection

20:14 - Procedure Walkthrough

23:22 - Different Strategies for Filter Removal

31:23 - Laser Techniques

34:47 - Sheath Sizing

36:06 - Enhancing Patient Safety

43:34 - Cheat Sheet for IVC Filters and Case Studies

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RESOURCES

BackTable Ep. 204- Filter Indications and Filter Tracking: Up Your Game with Dr. Stephen Wang:

https://www.backtable.com/shows/vi/podcasts/204/filter-indications-filter-tracking-up-your-game

BackTable Ep. 339- The Importance of a Multidisciplinary Filter Retrieval Program with Dr. Robert Ryu, Dr. Warren Clements, and Dr. Premal Trivedi:

https://www.backtable.com/shows/vi/podcasts/339/the-importance-of-a-multidisciplinary-filter-retrieval-program