Laser-Assisted Technology Allows Easier Removal of IVC Filters

MedicalResearch.com Interview with:

William T. Kuo, MD, FSIR, FCCP, FSVM Director, Stanford IVC Filter Clinic Director, IR Fellowship Program Founding Director, IR-DR Residency Program Associate Professor, Interventional Radiology Stanford University Medical Center Stanford, CA

Dr. William T. Kuo

William T. Kuo, MD, FSIR, FCCP, FSVM
Director, Stanford IVC Filter Clinic
Director, IR Fellowship Program
Founding Director, IR-DR Residency Program
Associate Professor, Interventional Radiology
Stanford University Medical Center
Stanford, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In the USA, over 250,000 IVC filters are now implanted each year, and rising filter use has led to an increase in filter-related morbidity and recognition of the potential complications from indwelling IVC filters. Consequently, the FDA has issued two safety communications alerting all physicians caring for patients with IVC filters to consider removing the filter as soon as protection from pulmonary embolism is no longer needed:

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm221676.htm

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm?so urce=govdelivery&utm_medium=email&utm_source=govdelivery

Despite heightened awareness, up to 40-60% of IVC filters cannot be easily removed using standard methods alone, after the filter becomes firmly embedded. Additionally, many patients have undergone prior placement of a permanent-type filter not even designed for retrieval, leaving them with few options for safe device removal. Although all of these patients can develop filter-related morbidity especially after chronic implantation, there is currently no routine option for removing embedded IVC filters refractory to standard retrieval methods. Our 5-year first-in-human study of a novel procedure—laser-assisted filter removal— demonstrates the safety and efficacy of this technique to treat such patients. In a cohort refractory to standard retrieval methods and high force, endovascular laser-assisted retrieval was overall safe and successful in removing a variety of filter types including permanent filters, regardless of dwell time and without the need for open surgery.

MedicalResearch.com: What should readers take away from your report?

Response: With rare exception, virtually any vena cava filter can now be removed percutaneously without the need for open surgery, regardless of dwell time, in a specialized center with expertise in advanced filter retrieval. This means patients with an indwelling filter, when refractory to standard retrieval methods, are no longer relegated to having a permanent filter. Furthermore, successful filter removal can prevent and alleviate filter-related complications. It may also allow some patients to be weaned from previously prescribed “filter-related” lifelong anticoagulation.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We are actually continuing our study to demonstrate safety and efficacy in an even larger cohort of patients. We also wish to elucidate feasibility of our technique in more challenging cases, for example in patients with indwelling filters associated with chronic caval occlusion.

MedicalResearch.com: Is there anything else you would like to add?

Response: This procedure changes the landscape of managing IVC filters by allowing thousands more patients each year to achieve successful filter removal. Our first-inhuman study shows that laser-assisted removal alleviates filter-related morbidity, prevents further risks associated with long-term implantation, and can also eliminate the need for (lifelong) filter-related anticoagulation.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Chest. 2016 Oct 8. pii: S0012-3692(16)59354-4. doi: 10.1016/j.chest.2016.09.029. [Epub ahead of print]
Laser-Assisted Removal of Embedded Vena Cava Filters: A 5-Year First-in-Human Study.
Kuo WT1, Odegaard JI2, Rosenberg JK3, Hofmann LV3.

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