621 - Gaps in IVC Filter Retrieval: Benchmarking Outcomes Through a Global Multi-Center Analysis

Monday, April 13, 2026

12:10 PM - 1:10 PM ET

Poster Presenter(s)

BM

Brittany Miles, MD

Radiology resident
Baylor University Medical Center, United States

Author/Co-author(s)

AS

Akash Sharma, MD, BS

Resident
Baylor University Medical Center, United States
JM

Jason Moss, MD, BS

IR attending
American Radiology Associates, United States

Purpose: Despite multiple FDA safety communications (2010, 2014) and multidisciplinary guideline statements (CHEST, 2016; SIR, 2020) recommending timely retrieval of inferior vena cava (IVC) filters, retrieval rates remain low. This represents not a knowledge gap but an implementation failure. We leveraged a global, multi-institutional dataset to quantify morbidity and mortality associated with indwelling filters compared to retrieval, entirely in the post-guideline era.

Materials and Methods: We queried the TriNetX Global Collaborative Network, encompassing >150 health systems and >150 million patient records, to identify adults undergoing IVC filter insertion (CPT 37191) between 2018–2025. Patients were stratified into Filter Remains (no retrieval) and Filter Removed (retrieval CPT 37193 within 1 day–6 months). Propensity score matching balanced demographic covariates. Outcomes included severe sepsis, hemorrhage, cerebral infarction, and all-cause mortality. Risk ratios (RR), risk differences, and numbers needed to treat (NNT) were calculated.

Results: A total of 58,549 patients across 155 health systems were analyzed (46,173 Filter Remains; 12,376 Filter Removed). Despite clear guidelines, only ~21% underwent retrieval. Retained filters were associated with significantly worse outcomes:

Severe sepsis: 10.8% vs 2.5% (RR 4.3; NNT=12).

Hemorrhage: 2.6% vs 1.1% (RR 2.3; NNT=69).

Cerebral infarction: 10.0% vs 4.9% (RR 2.0; NNT=20).

Mortality: 30.2% vs 4.2% (RR 7.2; NNT=4).

Conclusion: In a cohort spanning 2018–2025—well after FDA safety advisories and professional society guidelines—only one in five filters was retrieved, and retained filters were associated with sharply higher rates of infection, stroke, hemorrhage, and death. Absolute differences translate to one death prevented for every 4 filters retrieved. These findings demonstrate a persistent guidelines-to-practice gap and highlight the need for structured retrieval pathways, automated alerts, and institutional accountability to align practice with safety standards.