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Original Research |

Laser-Assisted Removal of Embedded Vena Cava Filters: A 5-Year First-in-Human Study

William T. Kuo, MD; Justin I. Odegaard, MD, PhD; Jarrett K. Rosenberg, PhD; Lawrence V. Hofmann, MD
Author and Funding Information

The first author wrote the initial draft of the manuscript and revised subsequent drafts based upon input from all coauthors. All coauthors vouch for the accuracy, completeness, and analysis of the reported data, and agree to publish the manuscript.

Conflicts of Interest: LVH has served as a consultant for Cook, Inc. None of the other authors have any relevant disclosures.

The abstract from this study was presented at the 2016 Society of Interventional Radiology Annual Scientific Meeting on April 5, 2016, in Vancouver, BC, Canada.

Clinical Trial Registration: NCT01158482 https://clinicaltrials.gov/ct2/show/NCT01158482

1Division of Vascular and Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3651, Stanford, CA 94305-5642

2Department of Pathology, Stanford University Medical Center, 300 Pasteur Drive, H-2110, Stanford, CA 94305-5627

Corresponding author: William T. Kuo, 300 Pasteur Drive, H-3651, Stanford, CA 94305-5642.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.09.029
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Abstract

Background  Many patients are subjected to the potential risks and morbidity associated with an indwelling IVC filter when standard methods fail to remove the filter. We evaluated the safety and effectiveness of the excimer laser-sheath technique for removing embedded IVC filters.

Methods  Over a 5-year period, 251 consecutive patients undergoing laser-assisted filter retrieval were prospectively enrolled. There were 103 men and 148 women (mean:46 years, range:15–82). Indications for retrieval included symptomatic acute IVC thrombosis, chronic IVC occlusion, and/or pain from filter penetration. Retrieval was also performed to prevent risks from prolonged implantation and potentially to eliminate the need for lifelong anticoagulation. After retrieval failed using 3 times the standard retrieval force (digitally-measured), treatment escalation was attempted using a laser sheath powered by a 308 nm XeCl laser. Success was defined as complete filter detachment and removal from the body. Primary safety outcomes were major procedure-related complications.

Results  Laser-assisted retrieval was successful in 249/251(99.2%)(95%CI:97.2-99.9%) with mean implantation of 979 days, range:37-7098 days(>19 years), among retrievable-type filters(n=211) and permanent-type filters(n=40). Average force during failed attempts without laser was 6.7 lbs versus 3.8 lbs during laser-assisted retrievals(p < 0.0001). The major complication rate was 1.6%(95%CI:0.4%-4.0%), and all were successfully treated. Successful retrieval allowed cessation of anticoagulation in 45/46(98%)(95%CI:88%-99%) and alleviated filter-related morbidity in 55/57 patients (96%)(95%CI:88%-99%).

Conclusions  The excimer laser-sheath technique is safe and effective for removing embedded IVC filters refractory to standard retrieval and high force. This technique can be used to alleviate or prevent filter-related morbidity and may allow cessation of filter-related anticoagulation.


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