5-Year Results of Laser-Assisted Vena Cava Filter Removal
This article reports favorable results for the use of the excimer laser sheath for IVC filter retrieval that has failed standard techniques. The laser sheath is FDA approved for removal of embedded venous pacemaker leads and any use for embedded IVC filters is off-label. Failed laser-assisted retrieval occurred with cylindrical-shaped filters (1 Optease and 1 Trapease) that contained a large amount of chronic thrombus that could not be captured within the sheath. In subsequent cases, authors reduced large amounts of chronic thrombus with a separate atherectomy catheter and/or angioplasty balloon allowing for laser-assisted filter removal. Not included in the major complications were 25 patients that developed a small (<2.5 cm) pseudoaneursym and 3 patients with small focal hemorrhage. All were self-limited or treated with temporary occlusion balloon inflation with resolution on immediate follow-up venography. Pseudoaneurysms larger than 2.5 cm were followed with cross sectional imaging and found to be resolved within 2-3 months. Data for this study was collected over a 5-year time period and authors do admit to a learning curve with laser sheath usage. Prior to routine force gauge use there were 4 cases of laser sheath cracking external to the patient with application of excessive force. Additionally, the major complications reported occurred earlier in their experience. The encouraging overall safety and efficacy, therefore, may not be transferable to early experience.
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Kuo WT, Odegaard JI, Rosenberg JK, Hofmann LV, Laser-Assisted Removal of Embedded Vena Cava Filters: A 5-Year First-in-Human Study, CHEST (2016), doi: 10.1016/j.chest.2016.09.029.
Jennifer Montgomey, MD, PhD