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CASE20191031_008
| ENDOVASCULAR - Peripheral Vascular Disease and Intervention | |
| Retrieve the Tilted IVC Filter with Every Technique You Could Imagine | |
| Shih-Rong Wang1 | |
| National Taiwan University Hospital, Taiwan1, | |
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[Clinical Information]
- Patient initials or identifier number:
SHC, 6056067
-Relevant clinical history and physical exam:
This is a 34-year-old woman without systemic diseases.In her thrid tremester of pregnancy in 2016, swelling and tenderness in left lower limb developed. Vascular duplex revealed thrombosis and total occlusion in left commom femoral vein. She kept Enoxaparin until she delivered the baby. Then she recieved catheter-directed thrombolysis and an IVC filter. After the thrombosis was resolved, she was admitted in for IVC filter retrieval. The physical exam was grossly normal and no lower limb swelling.
-Relevant test results prior to catheterization:
Previous study for thrombophilia, auto-immune or hematology disease was non-contributory. Before catheterization, she had normal liver and kidney function in blood test. The hemogram showed slightly microcytic anemia (Hb 10.5g/dL, MCV 77.6fL) with normal WBC and platelet count. The EKG showed normal sinus rhythm, and without STT change. The chest X-ray is normal without heart or lung lesion.
- Relevant catheterization findings:
After we punctured right internal jugular vein, we performed venography in IVC. The venography showed an IVC filter located in infra-renal vein level IVC with marked hook tilting to the left side. And the filter was not deformed or fractured. Then we try to retrieved this filter.
 diagnosis.avi diagnosis 2.avi |
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[Interventional Management]
- Procedural step:
We first tried simple loop snare to engage IVC filter hook but failed. A balloon-displacement technique was performed to get the filter untilted, but the snare still failed to catch the hook. Then we tried sling technique with Terumo wire around the circle through the base of filter and try snare the hook. However, we still cannot pull back IVC filter into the sheath due to poor co-axial alignment. We then tried sling technique with balloon-displacement technique to correct the alignment, but it failed. Because of the possible adhesion between filter hook and IVC wall. we performed hangman¡¯s technique to break the adhesion. After detaching the hook from IVC wall, we used Biotome¢ç (endomyocardial biopsy forceps) to capture IVC filter hook and reposition it. Finally, snare could nest into the hook of IVC filter and we successfully retrieved IVC filter within seconds.
  Biotome Forceps.avi- Case Summary:
Current guidelines advocate that we should retrieve IVC filter retrieval as possible in after venous intervention. However, to retrieve a tilted filter is not always easy. As an interventionist, it is mandatory to be familiar with different kinds of techniques for IVC filter retrieval. It is likely to use more than one techniques and even combine each other to retrieve difficult IVC filters. Finally, we repositioned the tiled IVC filter with endovascular biopsy forceps and easily retrieve it then.
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