Classification System for Inferior Vena Cava (IVC) Appearance Following Percutaneous IVC Filter Retrieval

Ningcheng Li, Roberto Galuppo, Maxwell Cretcher, Dennis Barbon, Cameron Loudill, Dominik Prosser, Greg Rufener, Mckinna Tillotson, Joseph O’Sullivan, Ramsey Al-Hakim, Khashayar Farsad, Younes Jahangiri, John A. Kaufman

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: There is no classification system for describing inferior vena cava (IVC) injuries. The objective of this study was to develop a standardized grading system for venographic appearance of the IVC following percutaneous IVC filter retrieval. Methods: A classification system for the appearance of the IVC on cavograms following percutaneous IVC filter removal was developed consisting of two grading elements; luminal characteristics and extravasation. Luminal narrowing from 0% up to 50% from any cause is grade 1; narrowing between 50 and 99% is grade 2; occlusion is grade 3; and avulsion is grade 4. Absence of extravasation is grade A, contained extravasation is grade B, and free extravasation is grade C. This system was then applied retrospectively to pre- and post-IVC filter retrieval cavograms performed at a single institution from October 2004 through February 2019. Results: 546 retrieval attempts were identified with 509 (93.2%) filters successfully retrieved. 449 cases (88.2%) had both pre-retrieval and post-retrieval imaging appropriate for application of the proposed classification system. Inter-rater reliability was 0.972 for luminal characteristics, 0.967 for extravasation, and 0.969 overall. Consensus grading demonstrated a distribution of 97.3% grade 1, 1.3% grade 2, 1.3% grade 3, and 0.0% grade 4 for post-retrieval luminal characteristics. For extravasation classification, 96.4% of the cases were classified as grade A, 2.7% grade B, and 0.9% grade C. Conclusion: A classification system was developed for describing IVC appearance after IVC filter retrieval, and retrospectively validated using a single center dataset.

Original languageEnglish (US)
Pages (from-to)1064-1073
Number of pages10
JournalCardioVascular and Interventional Radiology
Issue number8
StatePublished - Aug 2022


  • Caval extravasation
  • Caval injury
  • Filter retrieval
  • Grading system
  • IVC filter

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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