Failed Retrieval of an Inferior Vena Cava Filter.

Inferior vena cava (IVC) filters are devices used to lower the risk of critical pulmonary embolisms in patients with current deep vein thrombosis (DVT) or a high risk of developing such. These devices are used especially when there are contraindications to anticoagulants or when conservative therapy has failed. Typically, IVC filters are temporary and can be retrieved upon improvement in the patient's clotting status.  This case presents a 75-year-old female whose IVC filter retrieval failed. Once cleared by both cardiology and orthopedics, the decision was made to retrieve the IVC filter. First attempts at retrieval proved unsuccessful as the IVC filter was tilted approximately 30 degrees. Several attempts were first made to retrieve the filter using the snare-and-sheath technique to grab the hook at the top of the filter. The clinicians then also attempted to use endoscopic graspers, followed by several different laparoscopic graspers to aid in more precise gripping of either the hook or the tines of the filter. However, the grip was insufficient when attempting to retract it into the sheath. An additional venogram was then taken, which demonstrated further tilting of the IVC filter. The hook of the IVC filter appeared to reside in the origin of the right renal vein. After multiple failed attempts, a decision was made to leave the filter in place to avoid potential complications.  Retrieving IVC filters can present with difficulty. The development of advanced retrieval techniques, aside from the snare-and-sheath standard method, has helped increase the removal success rates, and complication rates remain low. Clinicians should exercise caution when IVC filters are difficult to retrieve, as this can lead to severe complications. Despite utilizing these techniques in complex scenarios, further study is needed to define and standardize the removal steps.