Navigating the Complexity of Inferior Vena Cava (IVC) Filter Retrieval : The Potential Role of Larger Co-axial Sheaths and the Implications of Dissection Forces

Inferior Vena Cava (IVC) filters play a pivotal role in managing thromboembolic diseases. However, their prolonged dwell time can lead to complications such as filter penetration and caval thrombosis, necessitating timely retrieval. The retrieval process can be complex, particularly when filters have become embedded within the venous wall due to the process of endothelialization. This process, influenced by a multitude of factors, results in the filter's integration into the vessel structure. We delve into the biological processes underpinning endothelialization, focusing on the proliferation and migration of endothelial cells, the role of inflammation and extracellular matrix remodeling, and the individual variability in this process. We explore the potential use of larger co-axial sheaths to aid in the retrieval of embedded filters. These sheaths can exert dissection forces at the filter site, facilitating its dislodgement and extraction while minimizing risk of vessel injury. Finally, we discuss the balance of forces - dissection and pull forces - essential for effective filter retrieval. This paper aims to shed light on the complex process of embedded IVC filter retrieval and the potential of using larger co-axial sheaths, emphasizing the need for further research in optimizing these techniques.