Abstract No. 601 Systematic Review Comparing the Safety Profile and Efficacy Between Advanced Inferior Vena Cava Filters Retrieval Methods

Inferior vena cava filters (IVC-F) are widely used to prevent life-threatening pulmonary embolism in patients at risk of venous thromboembolism; however, their long-term presence can be associated with various complications, including an increased risk of complicated retrieval. Advanced IVC-F retrieval techniques are often utilized when traditional removal is unsuccessful. To date, there are no systematic reviews comparing different advanced IVC-F removal techniques. This study investigates the efficacy and safety of the commonly utilized advanced IVC-F retrieval methods in existing literature. A systematic review of the Pubmed, Medline, and Web of Science databases was performed to identify studies utilizing advanced IVC-F retrieval techniques. Studies were included if advanced retrieval methods were used and if retrieval success and complication rates were described. Primary outcomes included retrieval success rates and complication rates. Three-level meta-analysis was performed for each outcome. Between-study heterogeneity was assessed by Cochran's Q-test and the I2 index. Meta-regression was conducted to assess the impacted degree of advanced retrieval methods on the observed heterogeneity. 33 papers consisting of 1410 subjects were included in the analysis comparing the six most utilized advanced retrieval methods: balloon displacement, excimer laser, forceps, hangman, loop snare, and snare over guidewire loop (SOGL). Meta-analysis revealed pooled rates for successful retrievals and complications as 93% (95% CI: 90% - 97%) and 4% (95% CI: 2% - 5%), respectively. There was statistically significant between-study heterogeneity for successful retrieval rates (p < 0.0001), while the between-study heterogeneity for complication rates was not statistically significant. Amongst method types, balloon displacement had a success rate of 57.7%, which is significantly poorer compared to forceps, hangman, loop snare, excimer laser technique, and SOGL (p = 0.006, p = 0.015 for SOGL, respectively). The complication rates amongst method types were comparable except when stratifying for minor complications; the minor complication rate for forceps was 3.5% higher than that of excimer laser (p = 0.0053). Systematic review of advanced IVC-F retrieval techniques have demonstrated to be safe and efficacious. Among the advanced techniques, balloon displacement was the least effective advanced method for filter removal while maintaining a similar complication rate as the other advanced techniques.