CLINICAL INVESTIGATION

Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

Anobel Tamrazi1 • Vibhor Wadhwa1,2 • Brian Holly1 • Nikhil Bhagat3 •

Jonathan K. Marx1 • Michael Streiff4 • Mark L. Lessne1,5

Received: 20 June 2015 / Accepted: 13 September 2015

� Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Abstract

Purpose To evaluate the feasibility, risks, and techniques

of percutaneous removal of permanent TrapEase and

Simon Nitinol IVC filters.

Materials and Methods Between August 2011 and

August 2015, 12 patients (5 women, 7 men; age range,

26–75 years) underwent an attempt at percutaneous

removal of permanent TrapEase (10) and Simon Nitinol (2)

IVC filters due to a history of IVC filter complications or

need for lifelong anticoagulation due to the filter. Medical

records were reviewed for filter dwell time, presence of

iliocaval deep venous thrombosis, procedural technique,

and complications.

Results Filter dwell times ranged from 7 days to 15 years

(mean 5.1 years). Successful removal of permanent IVC

filters was possible in 11 of 12 patients (91.6 %). In 1

patient, a chronically thrombosed IVC filter could not be

removed despite laser sheath assistance, but was success-

fully recanalized with the PowerWire RF guidewire. In the

failed retrieval attempt, a stent was placed through the

chronically thrombosed IVC filter with restoration of in-

line flow. One major complication of large venous groin

hematoma was encountered.

Conclusions In carefully selected patients, percutaneous

removal of permanent IVC filters can be performed safely

despite prolonged filter dwell times. Extraction of chroni-

cally embedded permanent IVC filters may be facilitated

by jugular and femoral approaches, often with laser sheath

assistance. Chronic filter thrombosis and caval scarring

may increase the risk of retrieval failure.

Keywords Inferior vena cava � TrapEase � IVCfilter � Simon Nitinol

Introduction

Venous thromboembolism (VTE) represents a spectrum of

a disease, which includes deep vein thrombosis (DVT) and

pulmonary embolism (PE). It is the third most common

& Anobel Tamrazi

atamraz1@jhmi.edu

Vibhor Wadhwa

vwadhwa1@jhmi.edu

Brian Holly

bholly3@jhmi.edu

Nikhil Bhagat

nikhibhagat@gmail.com

Jonathan K. Marx

jmarx9@jhmi.edu

Michael Streiff

mstreif@jhmi.edu

Mark L. Lessne

mlessne@gmail.com

1 Division of Vascular & Interventional Radiology, Johns

Hopkins University School of Medicine, 1800 Orleans Street,

Sheik Zayed Towers, Suite 7203, Baltimore, MD 21287,

USA

2 Department of Radiology, University of Arkansas for

Medical Sciences, Little Rock, AR, USA

3 Division of Vascular & Interventional Radiology, Kaiser

Permanente, McLean, VA, USA

4 Department of Hematology, Johns Hopkins University

School of Medicine, Baltimore, MD, USA

5 Vascular & Interventional Specialists of Charlotte Radiology,

Charlotte, NC, USA

123

Cardiovasc Intervent Radiol

DOI 10.1007/s00270-015-1214-0

cardiovascular illness after acute coronary syndrome and

stroke, with annual worldwide incidence rates ranging from

0.75 to 2.69 per 1000 individuals in the population [1].

Although anticoagulation is the therapy of choice for VTE,

it is not suitable in some patients with potential con-

traindications to anticoagulation, such as hemorrhagic

stroke, brain neoplasm, or craniospinal trauma. In such

patients, inferior vena cava (IVC) filters provide an alter-

native therapeutic strategy to prevent life-threatening PE.

The Prevention du Risque d’Embolie Pulmonaire par

Interruption Cave (PREPIC) study showed a significant

reduction in occurrence of PE in patients with proximal

DVT, as compared to patients without an IVC filter [2].

However, the study also showed an increased occurrence of

DVT with a 13 % IVC thrombosis rate at 8 years in a

population in whom approximately 50 % were receiving

anticoagulation. Other potential complications related to

long-term IVC filters include filter fracture, IVC perfora-

tion, and filter migration [3]. Due to the increased risk of

complications, the US Food and Drug Administration

issued an initial communication in 2010, recommending

that retrievable IVC filters be considered for removal once

protection from PE is no longer needed [4]. However,

patients who have permanent IVC filters, never designed

for removal, may still remain at risk for filter-related

complications. The TrapEase (Cordis, Bridgewater, NJ)

and Simon Nitinol (BARD Peripheral Vascular, Tempe,

AZ) filters are two such permanent devices, though their

removal techniques have been reported in few case reports

[5–10]. The purpose of this study was to evaluate the

feasibility, risks, and techniques of permanent TrapEase

and Simon Nitinol IVC filters in a series of 12 patients

using various endovascular techniques.

Materials and Methods

Institutional review board (IRB) exception was obtained

from our institution for this HIPAA compliant retrospective

study.

Patients

Between August 2011 and August 2015, 12 patients (5

women, 7 men; age range 26–69 years; average age

54.9 years) underwent an attempt at percutaneous removal

of permanent TrapEase (10 patients) or Simon Nitinol fil-

ters (2 patients) (Table 1). Inclusion criteria included a

history of IVC filter complication, such as filter-related

IVC thrombosis, or prescription of lifelong anticoagulation

due to the presence of the IVC filter. Patients with

asymptomatic IVC filters who required lifelong anticoag-

ulation regardless of IVC filter presence were not

considered for filter removal. Type of filter, dwell time,

indications for filter placement and retrieval, presence or

absence of caval clot on pre-procedural venogram, tech-

nique, route of access, and use of laser assistance were

recorded. The technique used in each case was categorized

whether removal was performed using standard vascular

sheaths from an internal jugular vein (IJV) approach, a

common femoral vein (CFV) approach, and if a laser

sheath was used. The data were recorded and analyzed

using Excel 2013 (Microsoft Inc., Seattle, WA).

Techniques of Filter Removal

Procedures were performed either under conscious sedation

or general anesthesia dependent on clinical scenario and

physician preference, by three fellowship trained vascular

& interventional radiologists at a high-volume, quaternary

care hospital. Initially, venography was performed using a

low-profile access sheath and a flush catheter in two pro-

jections to verify the position of the filter and assess for

IVC thrombus burden and contraindication to filter

removal. Thrombolysis of an acute or subacute iliocaval

thrombosis or recanalization of chronic iliocaval throm-

bosis was performed as needed; for acute iliocaval

thrombosis, patients were often scheduled for IVC filter

removal 2–4 weeks following initial thrombolysis.

For the filter removal procedure, 18–22 Fr Dry-Seal

sheaths (Cook Biotech Inc , West Lafayette, IN) were

routinely employed, allowing placement of a telescoping

12–18F sheath. All patients were heparinized (approxi-

mately 50 units/kg) during the retrieval procedures. An

in situ loop snare was formed around the filter apex using a

stiff glide wire (Terumo Corporation, Tokyo, Japan) that

was snared and externalized through the jugular or femoral

access; if both cranial and caudal controls of a TrapEase

filter were required, then the loop snare was formed from

both access sites (Fig. 1). Care was taken to form the loop

snare around the filter apex, avoiding passage lateral to the

apex and around the filter struts, which may distort the

filter and increase the difficulty of retrieval. For the Simon

Nitinol filters, the embedded tip was dissected using

endobronchial forceps (Bryan Corporation, Woburn, MA)

prior to loop snare (Fig. 2). In our experience, freeing the

filter tip allowed for a more stable loop snare formation

around the apex of the filter.

After successful wire loop of the filter apex, extraction

was attempted with blunt dissection using a 12–18F vas-

cular sheath often from simultaneous cranial and caudal

approaches. If the filter could not be sheathed due to

excessive resistance, a laser sheath (12–16F) (Spectranetics

Corporation, Colorado Springs, CO) was introduced

through either the jugular (Fig. 3) or femoral (Fig. 4) Dry-

Seal sheath, over the loop snare and a 6 or 7F sheath was

A. Tamrazi et al.: Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

123

Table 1 List of patients who underwent percutaneous IVC Filter removal

Patient:

Age,

M/F

IVC

filter

dwell

time

Type of

filter

Indication for

filter

placement

Indication for filter

removal

Post-filter caval

thrombosis, thrombolysis

or recanalization

performed before filter

removal

Technique of filter removal Complication

26, M 7 days TrapEase DVT with CI

to AC

Repeat US showed

no evidence of

DVT; suspected

misdiagnosis at

outside hospital

No Blunt dissection from

jugular (12f) and femoral

(12f) approach

None

42, F 8 years TrapEase DVT and PE

with CI to

AC

To cessation of AC Yes: thrombolysis Laser-assisted extraction

from femoral approach

(14f) with simultaneous

blunt dissection from

jugular access (14f)

None

52, F 9 months TrapEase DVT and

submassive

PE with CI

to AC

To allow cessation

of AC

No Blunt dissection from

jugular (14f) and femoral

(14f) approach

None

65, F 8 years TrapEase DVT with CI

to AC

To allow cessation

of AC

No Laser-assisted extraction

from jugular approach

only

Post-retrieval

caval stenosis

responsive to

angioplasty

(Grade B

complication)

62, F 4 years TrapEase PE with CI to

AC

To allow cessation

of AC

No Laser-assisted extraction

from jugular approach

only

None

69, M 6 years TrapEase DVT and PE

with CI to

AC

Filter thrombosis

with post

thrombotic

syndrome

Yes: Recanalization with

RF wire

Failure: Attempted laser-

assisted extraction from

jugular approach only

Delayed, large

groin

hematoma

1 week post

procedure

(Grade D

complication)

57, M 4 years TrapEase DVT with CI

to AC

To allow cessation

of AC

Yes:

In 2013 due to filter and

IVC thrombosis.

Laser-assisted extraction

from jugular approach

only

None

63, M 15 years Simon

Nitinol

DVT and PE

with CI to

AC

Filter thrombosis

with post

thrombotic

syndrome

Yes 11/2014 due to filter

and IVC thrombosis.

Laser-assisted extraction

(14f) from jugular

approach only

None

44, F 4 years Simon

Nitinol

PE with CI to

AC

To allow cessation

of AC

No Laser-assisted extraction

(16f) and blunt dissection

(18f) from jugular

approach

None

60, M 3 months TrapEase PE with CI to

AC

To allow cessation

of AC

No Blunt dissection (16f) from

jugular and femoral

approach

None

75, M 8 years TrapEase DVT with CI

to AC

Chronic IVC

thrombosis with

post thrombotic

syndrome

Yes due to thrombosis of

inferior IVC and iliac

veins

Laser-assisted extraction

(16F) from jugular

approach only followed

by iliac vein stenting for

recanalization

None

44, M 4 years TrapEase Prophylactic

for trauma

To allow cessation

of AC

Yes: caval thrombosis

4 months post-filter

placement after holding

AC for 1.5 weeks. No

thrombolysis

performed

Laser-assisted extraction

(16F) from jugular

approach and blunt

dissection with bronchial

forceps and 16F sheath

from CFV

None

PE pulmonary embolism, AC anticoagulation, DVT deep vein thrombosis, CI contraindication

A. Tamrazi et al.: Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

123

placed at the end of the laser sheath to provide a hemostatic

valve. The decision for cranial or caudal approach was

made based on the best apical loop snare position allowing

for filter collapse. The standard and laser sheaths were used

to collapse the filter as much as possible before activating

the laser. When laser activation was needed, gentle traction

was applied to the loop snare, while laser photoablation

was activated for 3–5 s bursts. Between laser bursts, the

larger external sheath was used for blunt dissection with

substantially greater traction.

A completion venogram was performed to evaluate for

procedural complications. Angioplasty and stenting was

performed subsequently as needed for flow limiting ste-

noses. Hemostasis was obtained at the access sites with a

single purse string suture. Early in the experience, patients

were admitted for overnight observation, but later the

procedure was performed on an outpatient basis. Post-re-

trieval complications were graded (A–D) according to their

severity. All patients were anticoagulated at least an

additional 2 weeks following filter retrieval.

Results

Filter dwell times ranged from 7 days to 15 years (mean

5.1 years). Successful removal of the permanent IVC filter

was possible in 11 of 12 patients (91.6 %) and restoration

of flow through the IVC was possible in 12 of 12 patients.

Fig. 1 A–C: A 52-year-old female with 9-month-old TrapEase filter.

A Loop snare is formed using a reverse curve catheter around superior

and inferior filter. B Filter is successfully removed using blunt

dissection with 12 and 14 Fr sheaths from superior and inferior

approaches. A 12F laser sheath was loaded into the system inferiorly,

but never activated since blunt dissection from above and below was

able to remove the filter successfully without need for photoablation.

C Completion cavagram shows no thrombus or vessel injury

A. Tamrazi et al.: Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

123

Blunt dissection with a vascular sheath from both IJV and

CFV alone was sufficient in extracting three TrapEase fil-

ters, while laser photoablation was required in 8 of 11

successful retrievals in this study. In the cases requiring

laser assistance, IJV access was used in 8 cases and CFV

access was used in 1 case, which was supplemented by

sheath from the IJV. The choice of laser activation from a

jugular or femoral approach was determined based on

which end attained a better in situ loop snare control of the

biconical filter (Fig. 3 and 4). The Simon Nitinol filters

Fig. 2 A-D: A 63-year-old

male with 15-year-old Simon

Nitinol filter. A Endobronchial

forceps used to detach the tilted

tip of the filter from the IVC

wall allowing for proper loop

snare. B Loop snare is formed

using a reverse curve catheter

around the apex of the filter.

C Filter is successfully removed

using blunt dissection with 18F

ad laser photoablation with 16F

sheaths from superior approach.

D Photograph of a 15-year-old

Simon Nitinol filter removed

with laser assistance from

superior approach

A. Tamrazi et al.: Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

123

were accessed only from IJV and both cases required laser

photoablation (Fig. 2). A history of caval thrombosis was

found in 6/12 cases (50 %). Post-retrieval complications

were seen in two patients—one patient developed caval

stenosis which was responsive to angioplasty (grade B).

The other patient had a delayed, large groin hematoma

1 week post procedure which resolved on further follow-up

(grade D).

In the one failed retrieval case, the caudal aspect of the

TrapEase filter was scarred into a chronically obliterated

IVC (Fig. 5) that required PowerWire RF guidewire

(Baylis Medical, Montreal, QC, Canada) for recanalization

after failure of sharp recanalization with back end of Meier

wire (Boston Scientific, Natick, MA). The filter could not

be removed despite moderate tension on the laser sheath.

To treat the patient’s obstructive symptoms, stent recon-

struction of the IVC with exclusion of the TrapEase filter

was performed (Fig. 5) with restoration of in-line caval

flow.

Discussion

IVC filters have been shown to prevent PE in patients who

have contraindications to anticoagulation or those with

recurrent DVT/PE despite anticoagulation therapy [11].

The introduction of retrievable filters has led to dramatic

increase in the use of these devices [12]. Although, some

retrievable filters that have been indwelling for extended

periods may be as difficult to remove as permanent ones,

permanent filters are not designed for retrieval and poten-

tially place the patient at risk for filter-related complications,

including caval thrombosis, migration, filter fracture, and

IVC perforation [2]. The TrapEase filter is a type of per-

manent IVC filter, which has a biconical design with double

level filtration. Kalva et al. reported their experience with

TrapEase filters in a series of 751 patients, with the filter

showing high clinical efficacy [13]. However, the compli-

cations in their series included filter components fracture

(3 %), thrombus within the filter (25.2 %), thrombus

extending beyond the filter (1.5 %), and near total caval

occlusion (0.7 %). Thus, one in every four patients receiving

the filter may develop at least partial caval thrombosis during

the dwell time of this permanent filter. The Simon Nitinol

filter (SNF) is made of a nickel and titanium alloy, which

allows it to be mechanically stable. Poletti et al reported a

long-term follow-up of SNF and found that 5.3 % patients

developed DVT, 3.5 % patients had thrombosis of IVC, and

the rate of these complications was similar in patients with or

without anticoagulation therapy [14].

In addition, although the recent American College of

Chest Physicians guidelines [15] do not consider a

Fig. 3 A-B: A 65-year-old

female with 8-year-old

TrapEase filter complicated by

caval thrombosis. After

successful thrombolysis, the

patient returned for laser-

assisted permanent IVC filter

extraction. A The filter was can

be removed using laser

photoablation from a superior

approach only. B Completion

cavagram demonstrates non-

flow limiting stenosis at the

filter site

A. Tamrazi et al.: Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

123

permanent IVC filter as an indication for extended anti-

coagulation, some hematologists may nonetheless advocate

for lifelong anticoagulation as long as the filter is in place

to minimize risk of caval thrombus, as is true in our center.

At our institution, nearly all patients in our series already

suffered a caval thrombosis or were committed to indefinite

anticoagulation due to their indwelling permanent IVC

filters. It has been suggested that the opposed biconical

design filters (TrapEase and OptEase) are more likely to be

associated with vena caval thrombosis, than the single-cone

design filters (Greenfield, Recovery, and Gunther-Tulip)

[16]. This may be due to the ‘‘margination effect’’ of the

filter wherein the captured thrombus marginates to the vena

caval wall, where the flow is the lowest and thus predis-

poses to thrombosis [17].

Removal of IVC filters once the patient has lost indi-

cation for caval filtration has been encouraged secondary

to these potential filter-related complications [18]. Chronic

filter implants lead to neointimal hyperplasia and dense

fibrosis, which tend to make the retrieval difficult [19].

Complex techniques to remove tilted, embedded, or frac-

tured retrievable IVC filters have been described [20].

Removal of permanent IVC filters has less often been

reported: Mousa et al. described a simple algorithm for

retrieval of two TrapEase filters up to 14 months after

implant [21] and Kuo et al have reported laser photoab-

lation for removal of SNF and biconical filters [22]. A

pre-procedural venogram is required in all patients to

exclude acute caval thrombus. If needed, pre-procedure

thrombolysis using tissue-type plasminogen activator

(tPA) or recanalization should be done. Laser photoabla-

tion was required in most of our successful cases (8/11);

however, attempting retrieval using standard blunt dis-

section first may be useful before using laser assistance

given the expense associated with the laser sheath. Tilted

or distorted filters are difficult to retrieve with standard

techniques, which require engaging the tip of the filter; for

removal of a Simon Nitinol filter, we used the endo-

bronchial forceps to free the tip from the caval wall

(Fig. 2), allowing for more stable loop snare of the filter

apex. In our failed TrapEase retrieval case, the inferior

portion of the TrapEase was densely embedded in chronic

caval occlusion (Fig. 5) and the filter was not removed

with moderate traction during laser sheath activation. The

patient’s obstructive symptoms were resolved by stent

reconstruction of his IVC, excluding the filter (Fig. 5).

Stenting through an IVC filter rather than removing it

remains a viable option with good outcomes [22] and

further studies regarding the outcomes and cost-effec-

tiveness of these two techniques is warranted.

Fig. 4 A-B: A 42-year-old female with 8-year-old TrapEase filter,

complicated by IVC thrombosis. A Following thrombolysis, the

patient returned for IVC filter removal using a combination of blunt

dissection from superior approach and laser photoablation from

below. B Close-up view of the superior and inferior approach sheaths

near the completion of filter extraction

A. Tamrazi et al.: Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

123

Our study had several limitations. First, the sample size

of twelve patients is small, but it should be emphasized that

only selected patients were considered for removal and

many patients do not have a strong enough indication to

warrant complex retrieval attempt. Secondly, we have only

short-term outcomes for these patients as long-term follow-

up is outside the scope of this report. Third, this series

includes patients with TrapEase and Simon Nitinol IVC

filters, but not all the available permanent filters in the

market, and thus we cannot extrapolate our findings to

other permanent filter types.

In conclusion, percutaneous removal of permanent

TrapEase and Simon Nitinol IVC filters can be performed

safely on carefully selected patients despite prolonged filter

dwell times. Extraction of chronically embedded filters

may require jugular and femoral approaches, often with

laser sheath assistance. Proper loop snare of the filter apex

can facilitate sheathing, but chronic filter thrombosis and

caval scarring may increase the risk of retrieval failure.

Although many, or most patients with permanent IVC

filters do not warrant an attempt at removal, our experience

and techniques described above can permit retrieval of

permanent IVC filters that have resulted in caval throm-

bosis or that consign the patient to indefinite anticoagula-

tion and all its associated risks.

Funding Dr Michael Streiff has received research funding from

Daiichi-Sankyo, Janssen, and Portola and consulted for BiO2Medical,

Boehringer-Ingelheim, Daiichi-Sankyo, Eisai, and Janssen Health-

Care. Dr Mark L Lessne has received research funding from Merit

Medical, consulted for Apriomed, and is an investigator on Cook

Medical IVC filter trial.

Compliance with Ethical Standards

Conflict of Interest Anobel Tamrazi, Vibhor Wadhwa, Brian

Holly, Nikhil Bhagat, and Jonathan K Marx have no conflicts of

interest.

Ethical Approval All procedures performed in studies involving

human participants were in accordance with the ethical standards of

the institutional research committee and with the 1964 Helsinki

declaration and its later amendments or comparable ethical standards.

Fig. 5 A-D: A 69-year-old male with a 6-year-old TrapEase filter

with chronically obliterated IVC requiring RF wire recanalization

prior to attempted filter retrieval. A Chronic IVC filter with

completely obliterated IVC. B and C After successful RF wire

recanalization of inferior IVC, attempt was made to remove the filter

from cranial approach with laser photoablation without success. The

caudal aspect of the TrapEase filter was scarred into the chronically

obliterated IVC preventing safe retrieval of the filter. D Successful

recanalization of internal iliacs and IVC with kissing 12 mm

E-Luminexx stenting through the embedded TrapEase filter

A. Tamrazi et al.: Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

123

Informed Consent Informed consent was obtained from all indi-

vidual participants included in the study.

References

1. Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A,

Hunt BJ, ISTH Steering Committee for World Thrombosis Day,

et al. Thrombosis: a major contributor to global disease burden.

Arterioscler Thromb Vasc Biol. 2014;34(11):2363–71.

2. Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P,

et al. A clinical trial of vena caval filters in the prevention of

pulmonary embolism in patients with proximal deep-vein

thrombosis. Prevention du Risque d’Embolie Pulmonaire par

Interruption Cave Study Group. N Engl J Med. 1998;338(7):

409–15.

3. Van Ha TG. Complications of inferior vena caval filters. Semin

Intervent Radiol. 2006;23(2):150–5.

4. Removing Retrievable Inferior Vena Cava Filters: Initial Com-

munication. US FDA; 2010 [19th April 2015]; Available from:

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm

221676.htm. Accessed 29 Sept 2015.

5. Yallampalli S, Irani Z, Kalva SP. Endovascular removal of a

permanent ‘‘TrapEase’’ inferior vena cava filter. Vasc Endovas-

cular Surg. 2013;47(5):379–82.

6. Nutting C, Coldwell D. Use of a TrapEase device as a temporary

caval filter. J Vasc Interv Radiol. 2001;12(8):991–3.

7. Kumar BC, Chakraverty S, Zealley I. Removal of a permanent

IVC filter. Cardiovasc Intervent Radiol. 2006;29(1):124–5.

8. Richard HM 3rd. Removal of a TrapEase inferior vena cava filter

for chronic abdominal pain 2 years after implantation. J Vasc

Interv Radiol. 2013;24(9):1419–21.

9. Naidu SG, Stone WM, Sweeney JP, Money SR. Endovascular

retrieval of a TrapEase permanent inferior vena cava filter from

the aorta. J Vasc Surg. 2012;55(1):237–9.

10. Morishita H, Yamagami T, Matsumoto T, Takeuchi Y, Sato O,

Nishimura T. Endovascular repair of a perforation of the vena

caval wall caused by the retrieval of a Gunther Tulip filter after

long-term implantation. Cardiovasc Intervent Radiol. 2011;

34(Suppl 2):S321–3.

11. Chung J, Owen RJ. Using inferior vena cava filters to prevent

pulmonary embolism. Can Fam Physician. 2008;54(1):49–55.

12. Anderson RC, Bussey HI. Retrievable and permanent inferior

vena cava filters: selected considerations. Pharmacotherapy.

2006;26(11):1595–600.

13. Kalva SP, Wicky S, Waltman AC, Athanasoulis CA. TrapEase

vena cava filter: experience in 751 patients. J Endovasc Ther.

2006;13(3):365–72.

14. Poletti PA, Becker CD, Prina L, Ruijs P, Bounameaux H, Didier

D, et al. Long-term results of the Simon nitinol inferior vena cava

filter. Eur Radiol. 1998;8(2):289–94.

15. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H,

Goldhaber SZ, et al. Antithrombotic therapy for VTE disease:

antithrombotic therapy and prevention of thrombosis, 9th ed:

american college of chest physicians evidence-based clinical

practice guidelines. Chest. 2012;141(2 Suppl):e419S–94S.

16. Ray CE Jr, Prochazka A. The need for anticoagulation following

inferior vena cava filter placement: systematic review. Cardio-

vasc Intervent Radiol. 2008;31(2):316–24.

17. Corriere MA, Sauve KJ, Ayerdi J, Craven BL, Stafford JM,

Geary RL, et al. Vena cava filters and inferior vena cava

thrombosis. J Vasc Surg. 2007;45(4):789–94.

18. Durack JC, Westphalen AC, Kekulawela S, Bhanu SB, Avrin DE,

Gordon RL, et al. Perforation of the IVC: rule rather than

exception after longer indwelling times for the Gunther Tulip and

Celect retrievable filters. Cardiovasc Intervent Radiol. 2012;

35(2):299–308.

19. Kuo WT, Cupp JS, Louie JD, Kothary N, Hofmann LV, Sze DY,

et al. Complex retrieval of embedded IVC filters: alternative

techniques and histologic tissue analysis. Cardiovasc Intervent

Radiol. 2012;35(3):588–97.

20. Kuo WT, Odegaard JI, Rosenberg JK, Hofmann LV. Excimer

laser-assisted removal of embedded inferior vena cava filters: a

single-center prospective study. Circ Cardiovasc Interv.

2013;6(5):560–6.

21. Mousa AY, AbuHalimah S, Yacoub M, Sheikh I, AbuRahma AF.

Tips and tricks for retrieval of permanent TRAPEASE� filters

for inferior vena cava. Vascular. 2014. doi:10.1177/170853

8114560456.

22. Neglen P, Oglesbee M, Olivier J, Raju S. Stenting of chronically

obstructed inferior vena cava filters. J Vasc Surg. 2011;54(1):

153–61.

A. Tamrazi et al.: Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

123