Novel endovascular retrieval of duodenal-penetrating inferior vena cava filters: a report of two cases and technical considerations.

Background: Inferior vena cava (IVC) filters are widely used to prevent pulmonary embolism in patients with venous thromboembolism. However, failure to remove retrievable filters within the recommended time window leads to significant long-term complications, the incidence of which has been gradually increasing. While filter tilt, adhesion, and venous wall penetration are commonly encountered, rare complications such as duodenal perforation by a filter foot or recovery hook present unique clinical challenges. Conventionally, such cases have necessitated open surgical removal due to the high risk of massive hemorrhage or bowel injury associated with standard endovascular retrieval techniques. Conventional endovascular retrieval is contraindicated for permanent filters or when the recovery hook has penetrated the IVC wall. This case series demonstrates the successful application of a novel endovascular technique in these two extreme scenarios. Case Description: We describe two patients with IVC filters that had been implanted for 9 and 8 years, respectively, who presented with epigastric pain and were found on gastroscopy to have a filter foot penetrating the duodenal wall. In the first case, a permanent Simon Nitinol filter lacked a recovery hook; in the second, the recovery hook of a Günther Tulip filter had itself pierced the IVC wall, and the filter foot was located in close proximity to the abdominal aorta. Both patients were deemed poor candidates for conventional intervention or refused open surgery. A novel endovascular technique was employed utilizing a combination of balloon-assisted intimal peeling, customized LOOP technology applied to the filter body, and real-time intra-arterial roadmap guidance via a pigtail catheter in the aorta. Conclusions: This novel endovascular technique offers a minimally invasive alternative for complex cases involving permanent filters and IVC-penetrating recovery hooks, with potential applicability in experienced interventional centers, though further validation is required.