Factors related to failure to remove retrievable VCFs
| Technical factors |
| Filter tilt/misalignment leading to filter tip embedded into the caval wall and inability to snare the filter hook |
| Filter thrombosis leading to inability to collapse the filter |
| Endothelialization (neointimal hyperplasia) of the filter attachments |
| Strut penetration through the caval wall |
| Prolonged dwell time |
| The window of opportunity for easy retrieval has passed |
| Patient-related factors |
| Patient loss to follow-up or death |
| Cancer |
| Goals of care (e.g. limited life expectancy, palliative) |
| Elderly |
| Patient refusal |
| Long distance from the medical center |
| Patient not aware of potential filter complication risks or ability to retrieve |
| Physician-related factors |
| Belief that the contraindication to anticoagulation is prolonged |
| Underappreciation of potential filter complication risks |
| Lack of expertise in removal of difficult filters |
| System-related factors |
| No hospital policy on filter retrieval |
| No one accepts responsibility for filter retrieval |
| Patients with filters not tracked prospectively |
| Patients with filters are not routinely invited for removal |
| Lack of coordination of care |
| Ineffective communication with the patient |
| Little guidance from professional specialty organizations |
| Technical factors |
| Filter tilt/misalignment leading to filter tip embedded into the caval wall and inability to snare the filter hook |
| Filter thrombosis leading to inability to collapse the filter |
| Endothelialization (neointimal hyperplasia) of the filter attachments |
| Strut penetration through the caval wall |
| Prolonged dwell time |
| The window of opportunity for easy retrieval has passed |
| Patient-related factors |
| Patient loss to follow-up or death |
| Cancer |
| Goals of care (e.g. limited life expectancy, palliative) |
| Elderly |
| Patient refusal |
| Long distance from the medical center |
| Patient not aware of potential filter complication risks or ability to retrieve |
| Physician-related factors |
| Belief that the contraindication to anticoagulation is prolonged |
| Underappreciation of potential filter complication risks |
| Lack of expertise in removal of difficult filters |
| System-related factors |
| No hospital policy on filter retrieval |
| No one accepts responsibility for filter retrieval |
| Patients with filters not tracked prospectively |
| Patients with filters are not routinely invited for removal |
| Lack of coordination of care |
| Ineffective communication with the patient |
| Little guidance from professional specialty organizations |