Retrievable inferior vena cava (IVC) filters are commonly placed to prevent pulmonary embolism when anticoagulation is contraindicated. Although guidelines strongly recommend timely removal, many filters become firmly embedded within the caval wall, rendering standard snare retrieval impossible. Advanced techniques are then needed to avoid open surgery. A 43-year-old male with a history of asthma, sleeve gastrectomy, and recent cholecystectomy had a retrievable IVC filter placed four months prior due to a minor IVC injury sustained during surgery. He presented for elective removal. Under general anesthesia in a hybrid operating room, initial attempts with a snare, ureteroscopic forceps, and Fogarty balloon dissection all failed owing to the firm embedding of the filter hook and struts. Rigid laparoscopic forceps were then introduced through a large-bore sheath. The strong jaws securely captured the filter tip and allowed careful detachment of each embedded strut. The filter was removed in one piece. Completion angiography revealed no extravasation. The patient recovered well and was discharged the next day without requiring pain medication. Rigid laparoscopic forceps provide a safe, effective, and readily available bail-out tool for complex embedded IVC filter retrieval when conventional and flexible endovascular techniques fail, even with short dwell times. This approach achieves high success rates with minimal morbidity and avoids the need for open surgical conversion.
Jahangir et al. (2026) studied this question.