Endovascular Laser Sheath Removal
Occasionally standard techniques to remove IVC filters are not successful. This can be caused by filters that have been in place for long periods of time causing the legs or hook to embed (stick) in the Inferior Vena Cava (IVC). This is caused by scar tissue forming. Also, if your filter has been in place for several years your doctor may feel it is unsafe to try and remove your IVC filter using standard procedures.
We have been successful at Northwestern in using an endovascular laser sheath to remove filters that have previously not been able to be retrieved.The laser is found inside a sheath or small tube that is placed inside the IVC and up to the filter. The laser is able to ablate the scar tissue attached to the filter allowing us to separate it from the IVC, collapse the filter into the sheath, and remove it.
We currently have an IRB approved prospective chart review study to assess the use, safety, and success of using the endovascular laser sheath to remove IVCfilters.
This technique can be used for:
1. Filters that could not be removed using standard techniques
2. Filters that have been in place for prolonged periods of time
3. Permanent filters traditionally considered irretrievable
Risks associated with this procedure are minimal and are usually resolved quickly. They include:
1. Bleeding at the site of the laser sheath insertion or in the IVC at the site of the filter removal.
2. Caval thrombosis (clot in IVC)
3. Infection (as with any procedure that punctures the skin)
1. Please contact the clinic coordinator by phone, e-mail, or NMH web paging for referrals, questions, or scheduling needs:
Jennifer Karp RN, BSN, CRN
You will need to provide the following information:
Type of filter in Place
Date of Filter placement
Reason for filter placement
Reason filter should be removed- failed previous retrieval attempt, permanent filter in place, filter in for long period of time, filter in place causing pain or other side effect.
2. You will be scheduled to be seen in the pre-op clinic where a history and physical will be done and blood drawn.
3. You will then be scheduled in the Operating room for removal of the filter using the laser device.
4. On the day of the procedure you will not eat or drink anything after midnight and arrive on the 5th floor of the Galter pavilion at the time given to you by the filter coordinator. You do NOT need to stop taking any of your anticoagulation (blood thinning) medications for this procedure.
5. You will receive sedation by an anesthesiologist for this procedure. Only a small incision will be made in your neck or groin to access the veins and place the sheath. This incision will be less than ½ an inch long.
6. You will recover from the procedure and sedation medication for a few hours and then will be discharged home. Someone must be with you to take you home this day.
The filter clinic coordinator will follow up with you 1 week after your procedure over the phone to see how you are doing. You will then be referred back to your primary physician.
By using this laser to remove IVC filters we hope to eliminate possible long term affects of IVC filters. A large amount of information and research has not been done on the long term effects of patients with filters in for prolonged periods or permanently. Filters that are left in place for long periods of time can be associated with some risks which may include: IVC occlusion (blockage), chronic deep vein thrombosis (DVT), post-thrombotic syndrome, filter fracture (a piece of the filter breaks off), or caval perforation (part of the filter pushes outside the IVC) which main cause pain or organ injury. Also some physicians place patients on life-long anticoagulation (blood thinning medications) when a permanent filter is in place putting patients at increased risk of bleeding complications.
Photothermal ablation with the excimer laser sheath technique for embedded inferior vena cava filter removal: initial results from a prospective study .Kuo WT, Odegaard JI, Louie JD, Sze DY, Unver K, Kothary N, Rosenberg JK, Hovsepian DM, Hwang GL, Hofmann LV.J Vasc Interv Radiol. 2011 Jun;22(6):813-23. Epub 2011 May 6.
The excimer laser sheath technique for embedded inferior vena cava filter removal . Kuo WT, Cupp JS. J Vasc Interv Radiol. 2010 Dec;21(12):1896-9. Epub 2010 Nov 3.
Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial .Wilkoff BL, Byrd CL, Love CJ, Hayes DL, Sellers TD, Schaerf R, Parsonnet V, Epstein LM, Sorrentino RA, Reiser C.J Am Coll Cardiol. 1999 May;33(6):1671-6.