Defining Prolonged Dwell Time: When Are Advanced Inferior Vena Cava Filter Retrieval Techniques Necessary?

Retrievable inferior vena cava filters (rIVCFs) were developed to provide temporary protection from pulmonary embolism while minimizing the risk of filter-related deep venous thrombosis associated with permanent inferior vena cava filters. In practice, however, the majority of rIVCFs are left in place permanently, with historic retrieval rates as low as 8.5%. Although poor clinical follow-up of patients with these devices plays an important role, prolonged filter implantation has been associated with retrieval failure rates as high as 43%. 11 Furthermore, prolonged rIVCF dwell time is associated with device-related complications, including fracture, migration, organ penetration, and increased risk of deep venous thrombosis. These concerns were mirrored in a 2014 safety communication issued by the US Food and Drug Administration urging rIVCF retrieval once no longer indicated. The development of advanced retrieval techniques has had a significant impact on rIVCF retrieval rates, particularly for devices that are in place for extended periods of time or are embedded. However, there is currently no specific definition of what rIVCF dwell time requires increased use of advanced retrieval techniques. We aim to define prolonged rIVCF dwell time by evaluating the time point when the risk of standard retrieval technique failure increases significantly, necessitating advanced retrieval techniques to maintain overall technical success of retrieval. Knowledge of this inflection point could foster removal of prolonged dwell rIVCF via referral to centers with expertise in advanced retrieval techniques, thereby adhering to the Food and Drug Administration mandate and optimizing patient outcomes.