The Value of Rotational Venography Versus Anterior–Posterior Venography in 100 Consecutive IVC Filter Retrievals

PurposeAccurately detecting inferior vena cava (IVC) filter complications is important for safe and successful retrieval as tip-embedded filters require removal with non-standard techniques. Venography prior to IVC filter retrieval has traditionally used a single anterior–posterior (AP) projection. This study compares the utility of rotational venography to AP venography prior to IVC filter removal.Materials and MethodsThe rotational venograms from 100 consecutive IVC filter retrievals over a 35-month period were evaluated retrospectively. The AP view of the rotational venogram was examined separately from the full series by a radiologist blinded to alternative imaging and operative findings. The venograms were evaluated for tip embedding, filter fracture, filter thrombus, and IVC thrombus. Statistical analysis was performed.ResultsUsing operative findings and peri-procedural imaging as the reference standard, tip embedding occurred in 59 of the 100 filters (59 %). AP venography was used to correctly identify 31 tip-embedded filters (53 % sensitivity) with two false positives (95 % specificity) for an accuracy of 70 %. Rotational venography was used to correctly identify 58 tip-embedded filters (98 % sensitivity) with one false positive (98 % specificity) for an accuracy of 98 %. A significant difference was found in the sensitivities of the two diagnostic approaches (P < .01). Other findings of thrombus and filter fracture were not significantly different between the two groups.ConclusionRotational venograms allow for more accurate detection of tip-embedded IVC filters compared to AP views alone. As this determines the approach taken, rotational venograms are helpful if obtained prior to IVC filter retrieval