Safety and Effectiveness of Advanced Retrieval Techniques for Inferior Vena Cava Filters Compared with Standard Retrieval Techniques: A Systematic Review of the Literature and Meta-Analysis

Purpose: To investigate the pooled safety and effectiveness of advanced retrieval techniques for inferior vena cava (IVC) filters compared with standard retrieval techniques through a systematic review of the literature and meta-analysis. Materials and Methods: A systematic search of retrievable IVC filters between 1980 and 2020 was conducted. Studies were included if both standard and advanced retrieval techniques were utilized in the same cohort, retrieval success rates and adverse event rates were described for each technique, and advanced techniques were employed after the failure of standard techniques. Study heterogeneity was assessed by the I-2 statistic. The outcomes included retrieval success rates and adverse event rates for standard and advanced retrieval techniques. Results: Of 1,631 articles, 21 (1%) studies met inclusion criteria. The study heterogeneity was high with an I-2 of 98%. The pooled random-effects outcomes included an overall standard retrieval success rate of 76% (95% confidence interval [CI], 65%-84%), with minor and major adverse event rates of 1% (95% CI, 0%-1%) and 1% (95% CI, 0%-1%), respectively. The overall pooled advanced retrieval success rates were 90% (95% CI, 82%-94%), with minor and major adverse event rates of 5% (95% CI, 2%-9%) and 4% (95% CI, 2%-6%), respectively. The standard retrievals were 16% less likely (risk ratio) to be successful (95% CI, 32% less likely to 4% more likely; P = .11). The major and minor adverse event rates were 88% and 84% less likely in standard retrievals compared with advanced retrievals, respectively (95% CI, 86%-94%; P < .0001; 95% CI, 70%-91%; P < .0001). Conclusions: Advanced retrieval techniques for IVC filters permit a higher retrieval success rate with low adverse event rates in cases of standard retrieval failure.