Difficult Removal of Retrievable IVC Filters: A Description of the "Double-Wire Restraining" Technique

We describe our experience with the use of the "double-wire restraining" technique to assist in the removal of two retrievable inferior vena cava filters: one had been misplaced in the right brachiocephalic vein with apex perforation of the vessel wall, and the second filter had migrated cephalad to straddle across both renal veins. The "double-wire restraining" technique consists of two stiff-shaft Glidewires (Terumo, Somerset, NJ) placed through the same introducer sheath and positioned on opposite sides of the filter. Both wires restrain the filter at the tip of the sheath as the sheath is advanced, thus allowing the operator to reposition the filter. This report details how this technique was used to realign two malpositioned filters and reposition the filter apices from their extravascular location, thus exposing them for ensnarement.