ALERT: Your health is top priority. We’re committed to providing reliable COVID-19 resources to keep you informed and safe.

IVC Filter Removal

During IVC filter removal, doctors place a catheter into the inferior vena cava to grab the small hook located at the end of the filter. Once attached, the catheter and the IVC filter are withdrawn from the body. The FDA recommends that doctors remove retrievable IVC filters once there is no risk of pulmonary embolism.

IVC filters are self-expanding metallic devices designed for implantation within the inferior vena cava, or IVC—the largest vein in the abdomen. The filters are inserted through a catheter via a small incision. The filters are designed to catch large blood clots and prevent them from migrating into the lungs. Once trapped, the patient’s body has more time to dissolve them naturally or in conjunction with blood thinning medication.

Older IVC filters were meant to be left in place permanently, but data has shown that filters left in place may lead to complications. Therefore, newer retrievable type IVC filters were intended to address these issues. According to the FDA and Radiological Society of North America IVC filters should be removed once the danger of a life-threatening clot is over.

Although the procedure to remove the filter is also minimally-invasive, removing the device may be challenging especially after prolonged dwell times. Excess scar tissue may form around the filter components increasing the risk of procedure-related complications such as bleeding and/or blood clotting. Filter fractures may occure and/or existing filter fragments may migrate during the retrieval procedure. In some cases, the filter may become further deformed and embedded in the blood vessel wall requiring a more advanced retrieval procedure at a specialized center.

Many patients have been told that their indwelling filters cannot be safely retrieved or that removal is not possible without invasive open surgery. However, due to research in the field, a variety of minimally-invasive treatment options now exist for most filter patients.

“Patients should educate themselves and be aware they might be candidates for advanced filter removal, without the need for invasive open surgery if standard methods fail. These minimally-invasive retrieval techniques are available at centers that specialize in advanced filter removal,” Dr. William Kuo, an interventional radiologist at Stanford Health Care, told Drugwatch.

Dr. Kuo pioneered advanced laser-assisted IVC filter removal—a minimally-invasive technique that can be used to remove embedded IVC filters without the need for open surgery.

How Are IVC Filters Removed?

Doctors remove retrievable filters in a way similar to how they implant them—using a catheter inserted through a small skin incision less than a centimeter long.

Health care providers first inject contrast or X-ray dye through the catheter to perform an angiogram in the vessel. This is important to make sure there are no large blood clots within the device prior to removal.

A snare device similar to a lasso is then inserted through the catheter and used to catch the filter hook. The catheter is then advanced over the filter in order to collapse it like a folding umbrella.

The filter is then removed through the catheter followed by removal of the catheter itself.

What to Expect Before Removal

The FDA recommends that retrievable IVC filters should be removed once the danger of a pulmonary embolism has passed.

If a patient with pulmonary embolism (PE) or deep vein thrombosis (DVT) cannot resume blood thinners right away, then the IVC filter may be left in place until the patient has recovered from their major illness or bleeding risk.

Ideally, the filter is not removed until the patient can safely resume taking blood thinners to prevent further blood clots

“The FDA recommends that implanting physicians and clinicians responsible for the ongoing care of patients with retrievable IVC filters consider removing the filter as soon as protection from pulmonary embolism is no longer needed.”

FDA Safety Communication, May 6, 2014

Patients Checked Before Procedure

In the weeks leading up to filter removal, doctors reassess their patient’s need for the filter along with potential complications that occasionally arise from the filter itself.

Medical steps taken prior to IVC filter removal may include:
  • Confirmation that the patient has recovered from the major illness that caused the blood clot
  • Confirmation that a patient has successfully initiated blood thinners to prevent further blood clots
  • Clinical exam for signs/symptoms of any new blood clot.
  • Follow-ultrasound for patients with known DVT to confirm it has resolved or reduced in size after starting blood thinners.
  • A reminder that most patients may continue their anticoagulation therapy during the filter removal procedures

Preparing for Removal

Before undergoing an IVC filter removal, patients should go over their medical history, including any current illnesses or medical conditions, with their doctor. Patients should report all medications and herbal supplements they are taking as well as any allergies, especially to drugs or anesthesia.

Immediately before the procedure, a patient may be advised to:
  • Eat only a light meal the night before
  • Avoid food and drink after midnight before the procedure
  • Adjust their insulin dose if they are diabetic
  • Wear a hospital gown and remove all jewelry for the procedure
  • Have someone to drive them home after the procedure

Any surgery carries risks. These can include infection or reaction to the drugs used during the procedure. In addition, IVC filter removal procedures carry their own complications.

Potential Complications that can occur when doctors remove an IVC filter
  • Blood Clot formation
  • Bleeding at the filter implantation site
  • Difficult retrieval causing long surgery times
  • Deformity to the filter
  • Migration of existing fractured filter fragments
  • Inability to remove the IVC filter

Removal Failure

If the filter has scarred into the blood vessel wall, removal may not be possible using standard methods. These patients may be considered for advanced filter removal after further evaluation at a specialized center.

Some centers offer advanced laser-assisted removal that may safely remove these devices using the same small skin incision.

In this procedure, a laser catheter is inserted through the outer catheter and used to gently ablate or remove scar tissue around the filter. This allows the filter to be freed, captured and removed using lower force.

Lawsuit Information
Impossible filter removal is among the serious complications people can sue for. Read more about IVC filter lawsuits.
View Lawsuits

What Happens If a Retrievable Filter Stays in Place Too Long?

Studies have shown that the longer an IVC filter remains in place, the more difficult it is to remove, and the greater the risk of filter-related complications.

“A filter sitting in a vein for a long enough time may cause scar tissue to form around it; eventually, the device anchors can become ingrown and firmly embedded within the vessel,” Dr. Kuo said.

Over time, filter components can also perforate through the vein wall while other parts can fracture. These broken pieces are at risk of migrating to the heart, lungs and other organs where they may cause damage.

Embedded IVC Filters

In many cases, IVC filters left in place too long, over several months to several years, cannot be safely removed using standard methods because they have scarred into the walls of the vein.

“Unfortunately, this complication rate can be really high,” Dr. Kuo told Drugwatch. “This may occur in up to 20 to 40 percent of cases depending on the dwell time and filter type.”

This has led to further research on advanced filter retrieval methods.

Illinois doctors Benjamin Lind and Hector Ferral documented a case in which they successfully removed a Cook Medical Günther-Tulip IVC filter more than nine years after it was implanted. The device had shifted, penetrating the wall of the vein and perforating the patient’s small intestine and part of her urinary tract.

Extensive Removal Planning

Advanced IVC filter retrieval may be offered when the standard technique — using a snare and catheter to sheath the filter fails.

“Many patients and their local doctors remain unaware that advanced filter retrieval techniques now exist that may allow successful minimally-invasive retrieval without the need for open surgery,” Dr. Kuo told Drugwatch.

Dr. Kuo pioneered a variety of advanced retrieval techniques including use of excimer laser to remove embedded IVC filters.

“The idea behind using excimer laser is to gently and precisely deal with scar tissue that forms around an embedded filter,” Dr. Kuo said.

The laser emits concentrated, ultraviolet light at its target, firing in bursts as short as one-billionth of a second. In eye surgery it may be used to vaporize part of the cornea’s surface, reshaping the eye to correct the patient’s vision.

In advanced filter retrieval, the same concept allows very precise removal of scar tissue around the filter 50-100 microns at a time. These are extremely thin layers; there are about 25,400 microns in an inch.  Ideally, once the scar tissue is removed, the filter becomes retrievable.

“The excimer laser technique is a major advancement that has allowed us to safely remove a variety of chronically implanted filters that were previously considered irretrievable,” Dr. Kuo said

Advanced Retrieval

Advanced IVC filter retrieval may be offered when the standard technique — using a snare and catheter to sheath the filter fails.

“Many patients and their local doctors remain unaware that advanced filter retrieval techniques now exist that may allow successful minimally-invasive retrieval without the need for open surgery,” Dr. Kuo told Drugwatch.

Dr. Kuo pioneered a variety of advanced retrieval techniques including use of excimer laser to remove embedded IVC filters.

“The idea behind using excimer laser is to gently and precisely deal with scar tissue that forms around an embedded filter,” Dr. Kuo said.

The laser emits concentrated, ultraviolet light at its target, firing in bursts as short as one-billionth of a second. In eye surgery it may be used to vaporize part of the cornea’s surface, reshaping the eye to correct the patient’s vision.

In advanced filter retrieval, the same concept allows very precise removal of scar tissue around the filter 50-100 microns at a time. These are extremely thin layers; there are about 25,400 microns in an inch.  Ideally, once the scar tissue is removed, the filter becomes retrievable.

“The excimer laser technique is a major advancement that has allowed us to safely remove a variety of chronically implanted filters that were previously considered irretrievable,” Dr. Kuo said

Please seek the advice of a medical professional before making health care decisions.

Terry Turner
Written By Terry Turner Writer

Terry Turner has been writing articles and producing news broadcasts for more than 25 years. He covers FDA policy, proton pump inhibitors, and medical devices such as hernia mesh, IVC filters, and hip and knee implants. An Emmy-winning journalist, he has reported on health and medical policy issues before Congress, the FDA and other federal agencies. Some of his qualifications include:

  • American Medical Writers Association (AMWA) and The Alliance of Professional Health Advocates member
  • Centers for Disease Control and Prevention Health Literacy certificates
  • Original works published or cited in Washington Examiner, MedPage Today and The New York Times
  • Appeared as an expert panelist on hernia mesh lawsuits on the BBC
Edited By
Medically Reviewed By

14 Cited Research Articles

  1. U.S. Food and Drug Administration. (2014, May 6). Removing retrievable inferior vena cava filters: FDA safety communication. Retrieved from: https://wayback.archive-it.org/7993/20170111070016/http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm
  2. Clair, D. (2013, April 10). Unretrieved IVC filters pose risk to patients. Cleveland Clinic. Retrieved from: https://health.clevelandclinic.org/unretrieved-ivc-filters-pose-risk-to-patients/
  3. Sarosiek, S., Crowther, M., & Sloan, M. (2013). Indications, complications, and management of inferior vena cava filters. JAMA Internal Medicine, 173(7), 513-517. Retrieved from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1669107
  4. Weinberg, I. (2016, October 31). Appropriate Use of Inferior Vena Cava Filters. Retrieved from: https://www.acc.org/latest-in-cardiology/articles/2016/10/31/09/28/appropriate-use-of-inferior-vena-cava-filters
  5. National Institutes of Health. (2016, October 14). Pulmonary Embolism. Retrieved from: https://medlineplus.gov/pulmonaryembolism.html
  6. Desai, T.R. et al. (2014, April). Complications of indwelling retrievable versus permanent inferior vena cava filters. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26993182
  7. Lind, B.B. and Ferral, H. (2015, March). Günther-Tulip Inferior Vena Cava Filter Removal 3334 Days after Placement. Retrieved from: https://www.sciencedirect.com/science/article/pii/S2352667X14000071
  8. American College of Radiology. (2016). ACR-SIR-SPR Practice Parameter for the Performance of Inferior Vena Cava (IVC) Filter Placement for the Prevention of Pulmonary Embolism. Retrieved from https://www.acr.org/-/media/ACR/Files/Practice-Parameters/ivc-fliterplacement.pdf?la=en
  9. PulmCCM. (2013, April 12). Inferior Vena Cava Filters: Debatable Benefit; Rarely Removed. Retrieved from: https://pulmccm.org/cardiovascular-disease-review/inferior-vena-cava-filters-placement-often-misguided-unhelpful-rarely-removed-jama-int-med/
  10. RadiologyInfo.org. (2016, June 21). Inferior Vena Cava Filter Placement and Removal. Retrieved from: https://www.radiologyinfo.org/en/info.cfm?pg=venacavafilter
  11. Northwestern Memorial Medical Center. (n.d.). Advanced Removal Techniques. Retrieved from: https://ivcfilter.nm.org/advanced-removal-techniques.html
  12. Uberoi, R., et al. (2013, December). British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/23511992
  13. University of Washington Medicine. (n.d.). Inferior Vena Cava (IVC) Filter Replacement or Removal. Retrieved from: https://www.uwmedicine.org/sites/default/files/2019-07/IR-Inferior-Vena-Cava-Filter.pdf
  14. Shah, K. et al. (2015, January). Advanced Techniques for Complicated IVC Filter Retrievals: A Clinical Perspective. Vascular Disease Management. Retrieved from https://www.vasculardiseasemanagement.com/content/advanced-techniques-complicated-ivc-filter-retrievals-clinical-perspective
View All Sources
Who Am I Calling?

Calling this number connects you with a Drugwatch representative. We will direct you to one of our trusted legal partners for a free case review.

Drugwatch's sponsors support the organization's mission to keep people safe from dangerous drugs and medical devices. For more information, visit our sponsors page.

(877) 790-0360