Any metal implant can cause complications. Presumably, the longer the dwell time, the more likely complications might develop—this has proven true of caval filters. Major complications include IVC thrombosis, embolization and migration, perforation, and element fractures. Permanent filters tend to have fewer problems than early versions of retrievable devices. These issues have gained rightful attention in the medical literature, and also in lay press and in medicolegal circles. Confounding this risk is the liberalization of insertion indications without methodical efforts to reach patients for their removal. Studies have shown notable disparities in physician compliance rates for placement indications by national guidelines and removal rates., Further, not all filters are created equal for both efficacy and risk: some designs may be more prone to complications, and others may be more prone to difficult retrieval. As mandated by the US Food and Drug Administration, patients receiving retrievable filters must be tracked longitudinally, and filters should be removed when there is no longer an ongoing indication for caval filtration. Practiced within guidelines and with programs for tracking and retrieval, the absolute risk is modest, and most complications are minor allowing clinicians to focus on the advantage of clot capture. In the PREPIC 1 trial, the only major complication associated with filters was filter thrombosis (8.9%); in the PREPIC 2 trial, the complications related to filter insertion were access site hematoma (2.6%) and filter thrombosis (1.6%).