Fig. 5

Initial cavagram shows an intact Bard Eclipse filter (Bard Peripheral Vascular, Inc., Tempe, AZ) IVC filter. Simple loop snare was unsucessful because of posterior tilt and embedded hook. The Hangman’s technique, a modification of the sling technique where a glidewire loop is created using a reversed curved catheter is created between the caval wall and filter hook to separate the tip of the filter from the wall of the filter, was used. After sucessful filter removal, ex-vivo examination showed two missing filter legs. Subsequent images showed one piece to be in the pulmonary outflow tract and one in the right atrium. The larger fragment was sucessfully retrieved from the pulmonary outflow tract but the piece in the right atrium could not be removed. Subsequent echocardiogram showed new severe tricuspid regurgitation which was managed medically. In situ leg fracture of certain types of filters is higher than others. The older generation Bard filters have a 25% rate of in situ leg fracture (Nicholson et al. 2010). While no published data exists on differential rates of fracture during retrieval by filter type, it is likely that filters prone to spontaneous in situ fracture are also more likely to fracture when subjected to mechanical stresses during retrieval