To dwell or not to dwell: Does timely removal of retrievable inferior vena cava filters improve the rate of device-related adverse events?

Studies have demonstrated that while permanent inferior vena cava filters (pIVCF) reduce the risk of PE, they increase the risk of lower extremity deep venous thrombosis (DVT). The development of retrievable inferior vena cava filters (rIVCF) allows the theoretical benefit of transient protection from PE without the long-term risk of filter implantation once removed. In actual practice, the majority of rIVCF are left in place permanently, without attempted retrieval. When retrieval of devices with prolonged implantation time is attempted, the procedure is often difficult and potentially higher risk. As a result, attempts at retrieval and successful removal of such devices has been historically low. However, there is mounting evidence that rIVCF, particularly those with prolonged dwell time, are associated with higher risk for adverse events relative to their pIVCF counterparts. The development of advanced retrieval techniques has positively impacted retrieval rates, though studies have reported higher rates of procedural adverse events when these techniques are employed. We aim to compare the risk of device- related complications associated with indefinite rIVCF implantation to the procedural risk of overall rIVCF retrieval and specifically complex rIVCF retrieval. We hypothesize that the safety profile of the retrieval procedure is favorable relative to indefinite rIVCF implantation.