In-sheath forceps‑to‑snare exchange during laser-assisted retrieval of a fractured OptEase inferior vena cava filter: a technical note

The pivotal role of bidirectional pulling with forceps, snare or both for removal of long-dwelling biconical vena cava filters is largely recognized. We describe an in-sheath transition from rigid laparoscopic forceps to a snare during a dual access laser-assisted retrieval of an embedded, fractured OptEase ® filter (Cordis). In 2022, a 79-year-old woman received the filter for iliofemoral deep vein thrombosis with contraindication to anticoagulation. After an unsuccessful attempt elsewhere, imaging at a 1360-day dwell time showed rightward tilting, severe embedding of both apices, transmural penetration and a fractured cranial strut. Under general anesthesia, laparoscopic forceps introduced through 22 F jugular and femoral sheaths established bidirectional traction, but to-and-fro manoeuvres failed to free the filter, requiring laser assistance. As the forceps could not fit the 16 F laser sheath, the 22 F femoral sheath was advanced to collapse the caudal apex within its lumen and the forceps were removed, leaving the apex coaxially constrained. An Amplatz Goose Neck ® snare pre-loaded within a 16 F GlideLight ® laser sheath easily recaptured the apex. With bidirectional traction restored, circumferential laser pulses ablated the neointimal tissue, and the filter was retrieved from below. Completion venography and cone-beam CT documented a retained 1-cm strut fragment and a clinically silent focal caval pseudoaneurysm, managed with balloon tamponade alone. She remained hemodynamically stable without transfusion and was discharged after three days on low-molecular-weight heparin; four-week CT showed resorption. To our knowledge, this in-sheath transition has not been described among the techniques adjunctive to filter ensheathment. It may be a useful option for long-dwelling biconical filters when advanced techniques with laparoscopic graspers have failed, overcoming device-sheath incompatibility and preserving bidirectional traction during laser-assisted dissection.