A New Catheter Technique to Correct Severe IVC Filter Tilt during Placement

• Main Authors: Sandeep T. Laroia, Justin J. Guan, Archana T. Laroia, Lucas Lenhart, Antony J. Hayes
• Format: Article
• Language: English
• Published: Thieme Medical Publishers, Inc. 2020-04-01
• Series: Journal of Clinical Interventional Radiology ISVIR
• Subjects: inferior vena cava; filter; tilt
• Online Access: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-3401346

Introduction Inferior vena cava (IVC) filter tilt is a common complication that occurs during and after filter placement. Severe tilting leads to reduced filter efficacy, lower retrieval success, and higher complication rates during retrieval. We present a novel catheter technique to correct severely tilted cone-shaped IVC filters without having to retrieve and replace the existing filter. Methods A retrospective review was performed for patients at our institution over three years who had severely tilted filters and underwent correction with the catheter technique. Indications for filter placement were categorized, and patient age, gender, tilt correction outcome, and complication rates were collected and analyzed. After severe tilting was noted on post-IVC filter deployment venogram, a Sos catheter was passed via the same femoral access site used for the filter placement. The catheter tip was reformed inside the cone of the filter and was used to push the filter tip back toward midline. Completion venogram was taken to document the amelioration of the tilt. Results Out of 28 patients who were found to have severely tilted filters on deployment and underwent correction with the catheter technique, 27/28 (96.4%) had successful correction. One (3.6%) had a minor complication where the filter struts became entangled with the catheter tip; however, simple maneuvering of the catheter and use of a stiff wire to straighten the catheter loop freed up the entanglement. No major complications occurred. Conclusion This technique is safe, effective, obviates filter replacement, and can be considered an additional management option for severe IVC filter tilt during placement.