Wire Loop Methods for Retrieval of Trapped Inferior Vena Cava Filters: 10-F Versus 16-F Sheath Technique

摘要

We read with great interest the article by Rubenstein et al (1) in the October 2007 issue of JVIR about a guide wire looptechnique for retrieval of trapped or tilted inferior vena cava (IVC) filters. We were quite impressed by the results of their technique, which demonstrated successful retrieval of four Recovery filters (C.R. Bard, Tempe, Arizona) and four Gunther-Tulip filters (GTFs) (Cook, Bloomington, Indiana) refractory to standard methods, but we were somewhat surprised that the basic guide wire loop idea was not new but in fact quite similar to a technique that we previously described a year earlier in the November 2006 issue of JVIR (2). Nevertheless, we examined their methods in detail because we were interested in any new variations and potential improvements to the technique. An important point that we learned from Rubenstein et al (1) is that it may be easier to create the guide wire loop by using a reverse-curve catheter engaged around the struts of the GTF, to more effectively redirect the wire, and we have since adopted this maneuver as another option for creating the loop. However, upon further scrutiny of their technique, we were surprised by the recommendation of placing a large 16-F sheath for filter capture (1). This differs significantly from our method, which requires only a 10-F sheath for GTF retrieval (2). Another major difference is that our technique employs a Goose Neck snare (ev3, Plymouth, Minnesota) tracked over both limbs of the guide wire loop to engage the hook and neck of the filter before capture by the sheath (2). We believe the addition of a Goose Neck snare, advanced over the guide wire loop, permits a lower profile for retrieval because the cephalad region of the GTF is engaged by the synergistic effect of the two snares in combination, allowing filter capture by a 10-F sheath. The technique by Rubenstein et al (1) employs no such snare but instead relies on a coaxial inner 8-F sheath. Although the 8-F sheath may engage the filter hook, it does not capture the entire filter and necessitates advancement of an overlying 16-F sheath for retrieval.