Pioneers in IVC filter removal

November 23, 2016

Most filters -- whether for water or a furnace -- eventually need to be removed or replaced to avoid complications.

Blood clot filters, which are implanted in the veins of people at risk of developing blood clots in their legs, require a similar precaution.

Complications have been found to arise when the filters, even those intended to be permanent, are left in longer than three to six months. These complications may include part of the filter breaking off and traveling to the heart and lungs, abdominal pain, filter tilt, and the filter tearing or creating a blockage in the veins of the abdomen (inferior vena cava) or in the legs. The chance of complications increases the longer the filter has been in place. Blood clot filters, also known as inferior vena cava (IVC) filters, potentially are dangerous and require specialized techniques to remove them.

Rush team traps, covers, folds and removes filters

Interventional radiologists at Rush University Medical Center have pioneered methods to remove filters that previously couldn't be removed for various reasons. Some of the newest pioneered techniques are published in the November issue of the Journal of Vascular and Interventional Radiology by the interventional radiology team at Rush.

"We have both the standard retrieval methods as well as the most advanced tools to remove any type of filter, and we have the medical expertise to treat any complications from the filter being implanted," says Osman Ahmed, MD, primary author and interventional radiologist at Rush University Medical Center and Rush Oak Park Hospital.

The techniques involve a careful method of catching or "snaring" the filter to hold it in place and then covering it to prevent parts of it breaking free. The team also uses tools such as alligator forceps and excimer laser,

Thanks to these methods, the Rush team has achieved a 100 percent retrieval rate over the past five years, including difficult-to-remove filters from patients who have been referred to Rush from other hospitals.

The minimally invasive procedure is performed on an outpatient basis using twilight (conscious) sedation in the interventional radiology suite, which is similar to an operating room but also includes special imaging equipment. More advanced retrievals are performed using general anesthesia due to the time it may take to remove the filter.

The filter removal is performed through a small incision in the neck or groin (the maximum size is around 5 mm) and the filter is removed using X-ray guidance to manipulate wires, catheters, and other devices necessary to remove the filter, which can be up to 29 mm in length.

All patients with an IVC filter should consult specialist about removing it

The Rush team lead by Bulent Arslan, MD, and Ulku Turba, MD, developed these techniques to remove IVC filters, which are implanted in the inferior vena cava, a large vein just below the kidneys, in order to trap blood clots before they travel to the heart and lungs and cause permanent damage. Arslan is associate professor of radiology and director, vascular and interventional radiology. Turba is associate professor of diagnostic radiology.

While there are a variety of risk factors and illness that can lead to blood clot formation, some blood clots produce no symptoms until they become dislocated and travel to other sites in the circulatory system. Some of the causes of blood clot formation can include heart conditions, prolonged immobility, smoking, surgery or inherited blood-clotting disorders.

IVC retrievable filters were approved by the U.S. Food and Drug Administration (FDA) in 2003 and 2004 and were recommended for deep vein thrombosis (leg pain due to circulation problems caused by clots) in 2012. The length of time the filter is left inside the body depends on the expected amount of time that protection is needed to prevent a blood clot from traveling up to the heart and lungs.

"Unfortunately, filters are not always removed once the initial threat of a blood clots traveling to the heart and lungs subsides, because there hasn't previously been awareness of the potential risks of leaving them in," says Sreekumar Madassery, MD, an interventional radiologist at Rush University Medical Center and Rush Oak Park Hospital.

The FDA now recommends that anyone who has an IVC filter talk to an interventional radiologist about having the filter removed as soon as possible. Not every filter should be removed, but everyone who has one should be evaluated.
For more information or to make an appointment at the IVC filter and DVT clinic at Rush, please call 312-563-4238.

Rush University Medical Center

Related Radiology Articles from Brightsurf:

Data science pathway prepares radiology residents for machine learning
A recently developed data science pathway for fourth-year radiology residents will help prepare the next generation of radiologists to lead the way into the era of artificial intelligence and machine learning (AI-ML), according to a special report.

Radiology research funding has increased -- still no association with citation rate
According to ARRS' AJR, almost half of the research articles published in AJR, Radiology, and European Radiology declared funding -- a proportion that has increased from 17% of articles in 1994 and 26.9% published between 2001 and 2010.

Unread second-opinion radiology reports waste health care resources
According to ARRS' American Journal of Roentgenology (AJR), 537 of 4,696 second-opinion reports--11.4%, likely underestimated, too--were not read by a clinician.

Radiology practices struggle to survive amid COVID-19
Private radiology practices have been especially hard hit by the COVID-19 pandemic, and the steps they take to mitigate the impact of the pandemic on their practice will shape the future of radiology, according to a special report from the Radiological Society of North America (RSNA) COVID-19 Task Force.

Social media and radiology -- The good, the bad, and the ugly
Radiologists examine social media and report #SoMe can be useful in education, research, mentoring and career development.

Experts stress radiology preparedness for COVID-19
Today, the journal Radiology published the policies and recommendations of a panel of experts on radiology preparedness during the coronavirus disease (COVID-19) public health crisis.

Radiology: Cardiothoracic Imaging publishes special report on vaping
Radiology: Cardiothoracic Imaging has published a special report on lung injury resulting from the use of electronic cigarettes, or 'vaping.' Researchers aim to raise awareness among radiologists and other medical professionals on how to identify e-cigarette or vaping product use-associated lung injury.

Radiology organizations publish statement on ethics of AI in Radiology
Experts in the use of artificial intelligence (AI) in radiology, from many of the world's leading radiology, medical physics and imaging informatics groups, today published an aspirational statement to guide the development of AI in radiology.

Rate of radiology resident recognition of non-accidental trauma
Radiology residency programs nationwide are not adequately teaching residents to accurately recognize and report child abuse, according to a study to be presented at the ARRS 2019 Annual Meeting, set for May 5-10 in Honolulu, Hawaii.

Radiology publishes roadmap for AI in medical imaging
In August 2018, a workshop was held at the National Institutes of Health (NIH) in Bethesda, Md., to explore the future of artificial intelligence (AI) in medical imaging.

Read More: Radiology News and Radiology Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to