Laparoscopic removal of retrievable inferior vena cava filters after failed or anticipated technically challenging endovascular retrieval: a retrospective case series of 28 patients

Background Laparoscopic retrieval of inferior vena cava filters (IVCF) offers a minimally invasive alternative for patients with failed percutaneous retrieval or anticipated technically challenging endovascular retrieval, but systematic evaluations are limited. Methods We retrospectively analyzed 28 patients who underwent surgical retrieval of IVCFs after failed endovascular retrieval or after preoperative imaging suggested anticipated technically challenging or potentially unsafe endovascular retrieval. Surgical techniques, perioperative outcomes, and a sensitivity analysis were described. Results Laparoscopic retrieval was attempted in all 28 patients and completed laparoscopically in 25 patients, yielding a laparoscopic completion rate of 89.3%. Three patients required conversion to open surgery, corresponding to a conversion rate of 10.7%. Complete filter removal was achieved in 27 patients, resulting in an overall technical success rate of 96.4% when open conversion cases were included. One patient experienced intraoperative IVCF injury with massive hemorrhage and died in the early postoperative period despite conversion to open surgery, vascular repair, transfusion, and intensive care support. No routine caval occlusion was required in completed laparoscopic cases. During follow-up, no recurrent pulmonary embolism, symptomatic IVCF occlusion, or procedure-related late mortality was observed among surviving patients. Conclusions Laparoscopic IVCF retrieval may be a feasible second-line option in selected patients with failed or anticipated technically challenging endovascular retrieval. The laparoscopic completion rate should be distinguished from the overall technical success rate, which includes cases completed after open conversion. Because this study lacked a comparator group, these findings should be interpreted as descriptive and should not be used to infer superiority over open surgery or advanced endovascular techniques.