1Abdulmohsen Ahmed Alhussaini,1Abdullah Saed Alghamdi, 1Abdullah Saed Alghamdi, 1Mohammed Alzahrani, 1Mohammed Mubarak Alomaim, 2Mohammed Mubarak Alomaim

1King Saud bin Abdulziz University for Health and Sciences, 2King Abdulaziz Medical City

Background(s):

Laser Sheath Assisted Removal of Inferior Vena Cava Filters with Long Dwelling Time is a technique which utilizes laser-tipped sheaths. The laser light only penetrates vascular tissue causing the target tissues to disintegrate into particles. This approach reduces the amount of energy used during difficult retrieval procedures, allowing permanent filters to be removed in less fluoroscopic and procedural time.

Material(s) and Method(s):

A retrospective study of patients who underwent laser assisted IVC filter removal. A total of nine patients (5 males) with mean age of 33.9 years (19 – 57 years) had Optease filters (n=9), and one Recovery filter. Mean dwelling median was 19 months (7-70 month). One patient had filter related IVC occlusion and one had chronic occlusion of the right iliac veins. Both patients underwent balloon angioplasty after filter retrieval without stent placement.

Result(s):

Laser sheath assisted filter removal was technically successful in all patients. Average cumulative fluoroscopic exposure time was 55 minutes, and the total dose area product (DAP) average was 279196 mGyCm2. Following retrieval, five individuals developed minimal IVC stenosis which required balloon angioplasty in four patients, one patient had only minor extravasation and did not require treatment. There were no major complications. Follow up imaging showed recurrent IVC occlusion in the patient who presented initially with occlusion. Small filter fragments embedded in the wall at the original site were noted in patients who presented with venous occlusion. The remaining patients had no IVC abnormality on follow up imaging.

Conclusion(s):

Laser assisted filter removal of IVC filters long dwelling time is feasible and safe after failed retrieval with standard techniques.