Advanced Removal Techniques
Endovascular Laser Sheath Removal
Occasionally standard techniques to remove IVC filters are not successful. This can be caused by filters that have been in place for long periods of time causing the legs or hook to embed (stick) in the Inferior Vena Cava (IVC). This is caused by scar tissue forming. Also, if your filter has been in place for several years your doctor may feel it is unsafe to try and remove your IVC filter using standard procedures.
We have been successful at Northwestern in using an endovascular laser sheath to remove filters that have previously not been able to be retrieved. The laser is found inside a sheath or small tube that is placed inside the IVC and up to the filter. The laser is able to ablate the scar tissue attached to the filter allowing us to separate it from the IVC, collapse the filter into the sheath, and remove it.
We currently have an IRB approved prospective chart review study to assess the use, safety, and success of using the endovascular laser sheath to remove IVCfilters.
Printable Education Pamphlets
This technique can be used for:
1. Filters that could not be removed using standard techniques
2. Filters that have been in place for prolonged periods of time
3. Permanent filters traditionally considered irretrievable
Risks associated with this procedure are minimal and are usually resolved quickly. They include:
1. Bleeding at the site of the laser sheath insertion or in the IVC at the site of the filter removal.
2. Caval thrombosis (clot in IVC)
3. Infection (as with any procedure that punctures the skin)
By using this laser to remove IVC filters we hope to eliminate possible long term affects of IVC filters. A large amount of information and research has not been done on the long term effects of patients with filters in for prolonged periods or permanently. Filters that are left in place for long periods of time can be associated with some risks which may include: IVC occlusion (blockage), chronic deep vein thrombosis (DVT), post-thrombotic syndrome, filter fracture (a piece of the filter breaks off), or caval perforation (part of the filter pushes outside the IVC) which main cause pain or organ injury. Also some physicians place patients on life-long anticoagulation (blood thinning medications) when a permanent filter is in place putting patients at increased risk of bleeding complications.
Please contact the clinic coordinator by phone, e-mail, or NMH web paging for referrals, questions, or scheduling needs:
Jennifer Karp RN, BSN, CRN
You will need to provide the following information:
The filter clinic coordinator will follow up with you 1 week after your procedure over the phone to see how you are doing. You will then be referred back to your primary physician.
Retrieval of Inferior Vena Cava Filters With Prolonged Dwell TimeA Single-Center Experience in 648 Retrieval Procedures. Kush R. Desai, MD; Robert J. Lewandowski, MD; Riad Salem, MD, MBA; Samdeep K. Mouli, MD; Jennifer K. Karp, RN; James L. Laws, BS; Robert K. Ryu, MD
Photothermal ablation with the excimer laser sheath technique for embedded inferior vena cava filter removal: initial results from a prospective study .Kuo WT, Odegaard JI, Louie JD, Sze DY, Unver K, Kothary N, Rosenberg JK, Hovsepian DM, Hwang GL, Hofmann LV.J Vasc Interv Radiol. 2011 Jun;22(6):813-23. Epub 2011 May 6.
The excimer laser sheath technique for embedded inferior vena cava filter removal . Kuo WT, Cupp JS. J Vasc Interv Radiol. 2010 Dec;21(12):1896-9. Epub 2010 Nov 3.
Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial .Wilkoff BL, Byrd CL, Love CJ, Hayes DL, Sellers TD, Schaerf R, Parsonnet V, Epstein LM, Sorrentino RA, Reiser C.J Am Coll Cardiol. 1999 May;33(6):1671-6.