Developing a clinical prediction model and analyzing risk factors linked to the challenge of eliminating extended recovery window filters

Developing a clinical prediction model and analyzing risk factors linked to the challenge of eliminating extended recovery window filters | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Developing a clinical prediction model and analyzing risk factors linked to the challenge of eliminating extended recovery window filters Qianqian Jiang, Yu Huang, Lijian Wang, Tianyi Zhu, Chong Li, Jiatao Li, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6941709/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To investigate the clinically significant risk factors for problematic inferior vena cava filter (IVCF) removal with a long retrieval window and to create a clinical model. Methods: Patients who had IVCF removal and IVCF type with lengthy recovery window IVCF in the Third Hospital of Hebei Medical University's vascular surgery department between June 2022 and June 2024 were gathered with routine anticoagulation prior to surgery. A total of 372 patients—211 men and 161 women—with ages ranging from 18 to 87 years and a mean age of 58.47 ± 13.32 years were enrolled in the study. Of them, 185 had Denali IVCF, 87 Octoparms IVCF, and 100 Option IVCF. In order to determine the independent risk factors for the difficulty of removing IVCFs from a long recovery window, univariate and multivariate logistic regression analysis were used. A columnar graphical model was built to internally validate the predictive efficacy and calibration of the model using the area under the curve (AUC) of the subject's work characteristics (ROC), calibration curve, and decision curve (DCA). The independent risk factors were examined using univariate and multivariate logistic regression analyses. Results: A risk prediction model for difficulty in removing IVCF was constructed after a multifactorial logistic regression analysis revealed that IVCF tilt angle, retention time, common iliac vein-IVC angle, and IVC width were independent risk factors for difficulty in removing IVCF with a prolonged retrieval window. Internal validation of the model revealed that the calibration curves were near the ideal curves; the ROC curve for the training set had an AUC of 0956, and the ROC curve for the validation set had an AUC of 0.985. Conclusion: The clinical risk prediction model built using these risk factors is useful in predicting the difficulty of removing IVCFs with prolonged retrieval windows and has clinical guidance value. IVCF tilt angle, retention time, common iliac vein-IVC angle, and IVC width are independent risk factors for difficulty in removing IVCFs with prolonged retrieval windows. Inferior Vena Cava Filter Risk Factors Inferior Vena Cava Clinical Prediction Modelt Deep vein thrombosis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1 INTRODUCTION Clinically useful inferior vena cava filters (IVCFs) are utilized to avoid fatal pulmonary embolisms (PE) brought on by deep vein thrombosis (DVT) [ 1 , 2 ] . Long-term IVCF retention, however, can result in a number of problems, such as tilting, displacement, fracture, inferior vena cava (IVC) perforation, and thrombosis [ 3 ] , which can endanger patient health and cause PE recurrence, ectopic embolism, or even death [ 4 ] . IVCF retrieval has progressively grown to be a clinical concern since long-term retained IVCFs are more difficult and risky to retrieve [ 5 ] . Advanced retrieval approaches (such as the LOOP technique, balloon-assisted transposition technique, etc.) can handle difficult situations more efficiently and increase the success and safety of IVCF retrieval as medical technology advances [ 6 , 7 ] . These methods, however, may result in longer procedure times, higher radiation exposure for both doctors and patients, and increased healthcare expenses, which put a financial strain on patients and may endanger both parties' health by raising the possibility of complications or secondary procedures [ 8 , 9 ] . Numerous parameters, such as IVCF location, kind, placement route, and retention period, affect the success of IVCF recovery. Current clinical research is focused on a number of challenging and hot subjects, including minimizing the incidence of problematic IVCF retrieval, optimizing the retrieval procedure, and lowering surgical risks and expenses. In order to investigate the independent risk variables for challenges in ICVF removal, we employed statistical approaches such logistic regression [ 10 ] and retrospectively examined patient data comparing traditional and sophisticated treatments for IVCF removal. A clinical risk prediction model was developed based on the analysis's findings in order to evaluate preoperative risk objectively and support decision-making. To increase prediction accuracy, the model integrates imaging and clinical data. It optimizes the surgical procedure, helps doctors create customized treatment regimens, lessens radiation exposure and problems, and lets doctors more thoroughly evaluate patients' risk stratification. 2 OBJECTS AND METHODS 2.1 Research Objectives Our center's intraoperative DSA image retention system and electronic medical record system were used to retrospectively gather clinical, imaging, and surgical data from patients who had IVCF removal over a long period of time, from June 2022 to June 2024. This included information on age, gender, whether there was a combination of bone fracture, hypertension, diabetes mellitus, coronary artery disease, cerebral infarction, type of filter, placement route, placement duration, IVCF placement plane, IVC width, tilt angle, IVC angle, and so forth. IVC width, common iliac vein-IVC angle, tilt angle, etc. This study concentrated on patients with IVCF placement via the femoral vein with a prolonged retrieval window because there were few and statistically insignificant cases of IVCF placement via the jugular vein at our center. Patients who satisfied the following inclusion criteria were the study's subjects. According to local regulations, written informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article. The research was approved by the Ethics Committee of The Third Hospital of Hebei Medical University. Ethics approval Number: KS-2025-254, Approval time: April 30th, 2025. We confirmed that all methods were performed in accordance with the relevant guidelines and regulations. This study is in line with the declaration of Holsinki. 2.1.1 Criteria for Inclusion 1) Long recovery window IVCF is the type of IVCF 2) Femoral vein is the placement route 3) Age (18 years or older but under 90 years) 4) Full clinical and imaging information 2.1.2 Criteria for Exclusion 1) The patient is older than 90 years 2) The jugular vein is the placement pathway 3) The IVCF type is either permanent or short-time window IVCF 4) Basic clinical or imaging data is absent or incomplete A total of 372 cases—185 (49.7%) of Denali IVCF, 87 (23.3%) of Octoparms IVCF, and 100 (20.0%) of Option IVCF—met the aforementioned inclusion and exclusion criteria. 2.1.3 An Explanation of IVCF Removal Challenges Regarding IVCF retrieval challenges, the medical community cannot agree. A research by Dinglasan [11] et al. identified a number of situations where IVCF retrieval is challenging, including: 1) major complications during or after retrieval, such as avulsion of the IVC wall, perforation bleeding, or severe stenotic occlusion; 2) serious complications resulting from the IVCF itself, such as breakage, displacement, or perforation of the IVC due to preoperative IVCF displacement; and 3) clinician application of a grasper to grasp the filter for more than five minutes or multiple unsuccessful attempts at the standard retrieval method, necessitating the use of an advanced technique for retrieval. 2.1.4 Grouping of Studies Every patient in this experimental investigation was divided into two groups based on whether or not improved recovery strategies were applied during IVCF removal. Of these, 39 patients used enhanced recovery techniques to remove their IVCF, whereas 333 patients underwent a traditional treatment. 2.2 Data Collecting for Surgery The tilt angle of the angiography machine, the angle between the IVC and the common iliac vein, and the IVC width in the plane of IVCF implantation were all measured using the measurement equipment and data gathered from the computer attached to the digital angiography machine. The angle between the axis of the IVC where the filter is located and the axis of the IVCF is known as the tilt angle (Figure 1A), the angle between the axis of the inferior IVC and the axis of the common iliac vein is known as the common iliac vein-IVC angle (Figure 1B), and the width of the IVC in the plane of IVCF placement is known as the IVC width (Figure 1C). 2.3 Methods of Statistics For statistical processing, R software version 4.3.3 and SPSS version 26.0 were used. The t-test was utilized to compare groups, and measurement data was presented as mean ± standard deviation( s). The chi-square test or Fisher's exact probability method was used to compare groups, and count and grading data were presented as rates or percentages. A multifactorial logistic regression model was constructed and a column-line graph was created in order to predict independent risk factors for IVCF removal difficulty. All of the patients involved in this experimental investigation were randomly assigned to a training group and a validation set in a 7:3 ratio. The model's validity and reliability were tested by the calibration curve and decision curve (DCA), while the predictive efficacy was measured by the area under the curve (AUC) of the subjects' operating characteristics (ROC). 3 RESUITS 3.1 Comparison of Baseline Characteristics of Training Set and Validation Set We randomly divided the patients included in this experimental study into training set and validation set according to the ratio of 7:3. Among them, there were 260 in the training set and 112 in the validation set. The general information of the two groups of patients was included in the statistical study, P>0.05, and the differences in the baseline characteristics of the two groups were not statistically significant (Table 1). 3.2 Analysis of univariates The statistical study included the training set of 260 patients, 27 of whom underwent advanced rehabilitation treatments. Six P<0.2 for age, placement path, retention time, IVC width, tilt angle, and iliac vein-IVC angle were identified as prospective risk factors for challenging IVCF retrieval in the one-way logistic regression, which comprised potentially relevant parameters (Table 2). 3.3 Regression Using Multiple Factors Table 3 shows that the four items of IVCF inclination angle, retention time, common iliac vein-IVC angle, and IVC width had P < 0.05, which were the independent risk factors for the difficulty of filter removal. These six risk factors were further included in the multifactorial analysis from the study's univariate analysis. 3.4 Line Chart Plotting As seen in Figure 2, a risk prediction model for filter removal difficulties was built using the four independent factors examined by multifactor logistic regression analysis. Each independent risk factor was given a Nomo score, which was then added up depending on the patient's clinical parameters. The patient's overall score indicated the likelihood that they would need the advanced retrieval approach. After that, the model was validated internally. To do this, the sampling on the column-line plots was repeated 1000 times using the Bootstrap method in the R software. The column line plot projected a high degree of agreement between the incidence of utilizing the enhanced recall approach and the actual incidence, demonstrating good predictive ability, since the calibration curve was near the ideal curve (Figure 3/Figure 4/Figure 5). 4 DISCUSSION Clinical practice has largely [12] accepted the implantation of an IVCF to prevent deadly PE caused to DVT. Studies conducted both domestically and abroad over the past ten years have demonstrated that the IVCF is a reasonably safe medical technology that can offer patients substantial advantages. The device's ability to successfully capture displaced thrombus has greatly decreased the morbidity and mortality of fatal PE. A thorough retrospective review conducted overseas, however, revealed that while IVCFs are successful in preventing PE, the risk of several complications—such as thrombosis, migration, vascular wall penetration, and fracture—increases significantly after more than 30 days following implantation [13] . According to a review by Hadied et al., a longer IVCF stay is linked to a higher risk of complications [14] and could have an impact on the patient's quality of life and prognosis. As a result, doctors should place a high priority on promptly retrieving IVCFs. IVCF removal is a difficult process; failure rates for traditional surgical excision range from 7% to 28% [15,16] . Our center's data revealed that the conventional retrieval failure rate was 10.48%, which is below the global average but still requires attention. In order to increase the success rate and guarantee that patients receive safe and efficient treatment, we are striving to refine the extraction procedure. We employed the more sophisticated advanced technique of advanced IVCF retrieval in order to overcome the difficulty of longer window IVCFs that are not retrievable through standard processes. The utilization of the Loop approach was the main focus of the current investigation. According to Desai et al. [17] , the success rate for retrieving a traditional process was approximately 82%, while the enhanced technique had an 18% success rate. Our facility achieved a high success rate of 99% (only one instance was not retrieved) and the overall success rate rose to 98% with the upgraded technique. This illustrates the Loop technique's enormous potential and offers insightful and useful lessons for therapeutic treatment going forward. Research on risk factors for challenging or even challenging IVCF retrieval is currently lacking, nevertheless. There aren't many well-known risk scoring systems to direct the risk stratification of IVCF recall issues. Analyzing the clinical risk factors of IVCF retrieval difficulties, investigating and developing an efficient clinical risk prediction model [18] , giving doctors a more precise and trustworthy foundation for advice, improving the IVCF retrieval protocol, and lowering patient costs and radiation exposure duration were the objectives of this study. The current study's findings demonstrated that the difficulty of removing IVCF with a long retrieval window was influenced by independent risk factors, including IVCF tilt angle, retention time, common iliac vein-IVC angle, and IVC breadth. IVCF tilt that resulted in wall adherence of the retrieval hook was a substantial risk factor for retrieval difficulty, and the angle of IVCF tilt was significantly linked with IVCF retrieval difficulty [19] . Steyerberg et al. showed that IVCF tilt more than 15° and IVCF retrieval hook embedding in the venous wall were both significant indicators of IVCF retrieval difficulties [20] . Recovery risk rose 2.38 times when IVCF tilted between 5 and 15 degrees [11] . The IVCF was prone to tilting when the angle between its long axis and the long axis of the IVC was more than 20°. This led to the recovery hook becoming fastened to the wall and made recovery more challenging [21] . This is in line with what we found. According to pertinent international research, IVCF tilt may be produced by IVC tortuosity, IVCF placement position, placement technique, and extra-luminal compression brought on by abdominal tumors, aortic aneurysms, and other conditions [22] . This implies that we should precisely understand the indications for IVCF installation and adhere to the operating standards. Long-term IVCF retention may result in endothelial hyperplasia and the IVCF support foot adhering tightly to the IVC, making removal more challenging. According to a study conducted abroad, the endothelium started to proliferate seven days after the IVCF was placed [23,24] , thickened significantly and fixed the IVCF after two weeks [25,26] , stabilized endothelial proliferation after four to eight weeks, and the IVCF was essentially fused with the endothelium within forty to sixty days. 30 As a result, prompt removal of the long-retained IVCF is essential. [27] The average time for successful IVCF removal was 58.7 days, while the average time for failure was 95.4 days, according to Marquess et al. In order to guarantee prompt IVCF removal once the risk of fatal PE has decreased, doctors should maintain continuous communication with patients who have IVCF placement. IVCF removal becomes more challenging when the common iliac vein-IVC pinch angle is greater. The longer the delivery sheath's axis is parallel to the IVC's long axis, the closer the IVCF's head end is to the lumen's center upon release, and the less likely wall apposition is, the smaller the patient's common iliac vein-IVC angle is. According to Oseph et al. [28] , the higher the IVCF is at the time of release, the less likely it is to tilt. This is because the closer the plane of placement is to the top at release, the more parallel the delivery sheath is with the long axis of the IVC, the smaller the angle of deflection that is created, and the lower the bending degree of the delivery sheath during placement. This is because the transport sheath's curvature during placement decreases as the release plane gets closer to the top. This is because the transport sheath is more parallel to the long axis of the IVC and the deflection angle is smaller. IVC width and IVCF retrieval difficulties are significantly correlated: the wider the IVC, the more challenging it is to recover the IVCF, which is in line with the findings of the Laidlaw et al. study [29] . Additionally, it has been observed that thinner IVCs have a higher probability of tilting the recovery hook against the wall, which makes IVCF retrieval more challenging [10] . Therefore, more research is still needed to confirm the impact of IVC width on IVCF retrieval. By combining several variables to precisely forecast medical outcomes or evaluate the impact of interventions, clinical risk prediction models support clinical decision-making [30] . Physicians can swiftly select the most effective examination or treatment plan by using column line graphs, which can clearly show the relationship between predictors and outcomes [20] . Four important risk factors (IVCF tilt angle, retention time, common iliac vein-IVC pinch angle, and IVC width) were included in this study's risk prediction model for IVCF removal difficulty with a prolonged retrieval window. A clinical risk prediction model was developed and validated, and it was displayed using a column-line diagram to help clinicians determine the likelihood that removing an IVCF would be difficult. In order to give clinicians an easy-to-use risk assessment tool, this study creatively integrated risk factor analysis with the development of risk prediction models. The findings have both theoretical and clinical significance, contributing to better patient outcomes and quality of life as well as the effectiveness and success of filter removal. Limitations Due to clinical and equipment limitations, the study only examined left-right tilting of the filter and did not investigate the effect of anterior-posterior tilting on IVCF removal. Even though the risk prediction model showed good predictive performance, it was only internally validated and lacked external data as a single-center study; future external validation using multiple samples and multicenter trials will be required to draw more thorough and reliable conclusions. 5 CONCLUSION IVC width, retention duration, common iliac vein-IVC angle, and IVCF tilt angle are all independent risk variables for IVCF removal difficulties during extended retrieval windows. The difficulty of IVCF removal is greatly increased when these risk factors are present, so clinicians should take precautions to lower the procedure's risk. Convenient for clinical use, the clinical risk prediction model developed in this study using the aforementioned independent risk indicators in conjunction with a column-line diagram can forecast the likelihood of IVCF removal difficulty. The methodology is effective and helps doctors make decisions. Abbreviations Name Variable assignment and description IVCF inferior vena cava filter DVT deep vein thrombosis PE pulmonary embolisms IVC inferior vena cava ROC Receiver Operating Characteristic AUC Area Under Curve DCA Decision Curve Analysis Declarations Conflict of interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Data availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. If you need to ask us for the data of this study, please contact YanRong Zhang, Email: [email protected] or Fengkai Wang, Email: [email protected] . Human Ethics and Consent to Participate declarations Written informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article. The research was approved by the Ethics Committee of The Third Hospital of Hebei Medical University. Ethics approval Number: KS-2025-254, Approval time: April 30th, 2025. I nformed consent This study has obtained the informed consent of the participating patients.Informed consent was obtained from all subjects and/or their legal guardian(s). Author contributions Writing – original draft: Qianqian Jiang, Yu Huang, Lijian Wang, Tianyi Zhu, Chong Li, Jiatao Li Writing – review & editing: Yaqi Wang, Ruijiao Gao, Liang Li, Xiangdong Liu, YunSong Li, Yanrong Zhang, FengKai Wang Data curation: Qianqian Jiang, Yu Huang Project administration: Yanrong Zhang, FengKai Wang Funding Medical Science Research Project of Hebei(Analysis of Risk Factors Associated with Difficulty in Removing Long-term Recycled Window Filters and Establishment of a Clinical Prediction Model). References Imberti D, Dentali F, Ageno W, et al. Evidence and clinical judgment: vena cava filters[J]. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6941709","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488515965,"identity":"e5d97b99-37de-4324-9c9c-19c4626465af","order_by":0,"name":"Qianqian Jiang","email":"","orcid":"","institution":"Third Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qianqian","middleName":"","lastName":"Jiang","suffix":""},{"id":488515968,"identity":"9af5b1cb-4d15-4b13-8fb5-836c754907c6","order_by":1,"name":"Yu Huang","email":"","orcid":"","institution":"Third Hospital of Hebei Medical 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Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIie2Rv0rEQBCHNwRis2i7IXL3CiMLwerOR9kQME1OLFNYJBxsGsE2IvgY1hMWtIlce6BFrlGLK9YuhagrNjZJLAX3g2mG3wfzhxCL5a+SmWLEKVoBHxNvp8RxpflWlqBPXb5LG/FbhXh+pd3omh3BYBru7tULZo+zy1LlAQUvkYwI0mU3/UpzcnyIzVN8RaOcU6ALGRTonDcPvUqIachfpYonJMpjCmwh91G4jhxQVtsQ6nej7G1yRQESjwkYVtYpb+tczQIWFUUFQowq8/U2JHirhF9tlkQDHkhz5HpoF/8i5RrP1JytkudOvOF0WpZ122X9isEzLzG7/2zhUN7g6q8BR0IWi8Xyn/kEcxZislA9reYAAAAASUVORK5CYII=","orcid":"","institution":"Third Hospital of Hebei Medical University","correspondingAuthor":true,"prefix":"","firstName":"FengKai","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-06-20 22:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6941709/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6941709/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87574945,"identity":"1cd579ec-19ad-43d3-8aae-3996f666b656","added_by":"auto","created_at":"2025-07-25 11:34:08","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":85042,"visible":true,"origin":"","legend":"\u003cp\u003eDifficult inferior vena cava filter\u003c/p\u003e\n\u003cp\u003eA: Inclination angle of IVCF;\u003c/p\u003e\n\u003cp\u003eB: Typical pinch angle between the iliac vein and IVC\u003c/p\u003e\n\u003cp\u003eC: IVC widths for IVCF installation planes\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6941709/v1/8794d433dcf24769c2c3c019.jpg"},{"id":87576378,"identity":"bc7a1ded-70c8-40ec-a488-fec84c1272bf","added_by":"auto","created_at":"2025-07-25 11:42:08","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55319,"visible":true,"origin":"","legend":"\u003cp\u003eModel for predicting risk\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6941709/v1/92b0b455754c23fac6e911dd.jpg"},{"id":87577084,"identity":"e9964fa9-66dc-4e57-881c-84ec6b8463d5","added_by":"auto","created_at":"2025-07-25 11:50:08","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":34257,"visible":true,"origin":"","legend":"\u003cp\u003eCalibration curves for internal validation of column-line diagrams\u003c/p\u003e\n\u003cp\u003eA: Calibration curves for a training set\u003c/p\u003e\n\u003cp\u003eB: Calibration curves for validation sets\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6941709/v1/3505c035fe2c8630f263215a.jpg"},{"id":87576380,"identity":"d0c5708f-7e1c-405d-afa4-d234a086a17d","added_by":"auto","created_at":"2025-07-25 11:42:08","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":44402,"visible":true,"origin":"","legend":"\u003cp\u003eColumn line diagram validation ROC\u003c/p\u003e\n\u003cp\u003eA: ROC curve for training\u003c/p\u003e\n\u003cp\u003eB: ROC curves for validation sets\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6941709/v1/51e5d1bd21f3c1171455c279.jpg"},{"id":87574948,"identity":"a182879a-d88d-4146-9adb-c0945a18a1a0","added_by":"auto","created_at":"2025-07-25 11:34:08","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":32513,"visible":true,"origin":"","legend":"\u003cp\u003eThe risk model's decision curve\u003c/p\u003e\n\u003cp\u003eA: Training set DCA\u003c/p\u003e\n\u003cp\u003eB: Validation set DCA\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6941709/v1/644f6a729d4ef9cd17675b83.jpg"},{"id":89874090,"identity":"38bf4b5c-b9eb-4d49-ac89-40d94f07cf16","added_by":"auto","created_at":"2025-08-26 03:32:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":925988,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6941709/v1/32d9dc3b-d6dc-4a32-9896-53ee3c6a7d19.pdf"},{"id":87577083,"identity":"a7c4bf46-5f8e-4521-8f0c-dd733c2fc095","added_by":"auto","created_at":"2025-07-25 11:50:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23341,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6941709/v1/3fe2dbaa52247d0d2c0018a2.docx"},{"id":87574942,"identity":"e28fdd43-5567-4ef2-b59d-a144635b266f","added_by":"auto","created_at":"2025-07-25 11:34:08","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":21192,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6941709/v1/723aa7f195a709fbeb1893b1.docx"},{"id":87576376,"identity":"32438c61-655a-4e72-a22c-89dd74667956","added_by":"auto","created_at":"2025-07-25 11:42:08","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":13411,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-6941709/v1/ee3b44491bf666ad8b5ad9c0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Developing a clinical prediction model and analyzing risk factors linked to the challenge of eliminating extended recovery window filters","fulltext":[{"header":"1 INTRODUCTION","content":"\u003cp\u003eClinically useful inferior vena cava filters (IVCFs) are utilized to avoid fatal pulmonary embolisms (PE) brought on by deep vein thrombosis (DVT)\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Long-term IVCF retention, however, can result in a number of problems, such as tilting, displacement, fracture, inferior vena cava (IVC) perforation, and thrombosis\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, which can endanger patient health and cause PE recurrence, ectopic embolism, or even death\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. IVCF retrieval has progressively grown to be a clinical concern since long-term retained IVCFs are more difficult and risky to retrieve\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAdvanced retrieval approaches (such as the LOOP technique, balloon-assisted transposition technique, etc.) can handle difficult situations more efficiently and increase the success and safety of IVCF retrieval as medical technology advances\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. These methods, however, may result in longer procedure times, higher radiation exposure for both doctors and patients, and increased healthcare expenses, which put a financial strain on patients and may endanger both parties' health by raising the possibility of complications or secondary procedures\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eNumerous parameters, such as IVCF location, kind, placement route, and retention period, affect the success of IVCF recovery. Current clinical research is focused on a number of challenging and hot subjects, including minimizing the incidence of problematic IVCF retrieval, optimizing the retrieval procedure, and lowering surgical risks and expenses.\u003c/p\u003e\u003cp\u003eIn order to investigate the independent risk variables for challenges in ICVF removal, we employed statistical approaches such logistic regression\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e and retrospectively examined patient data comparing traditional and sophisticated treatments for IVCF removal. A clinical risk prediction model was developed based on the analysis's findings in order to evaluate preoperative risk objectively and support decision-making. To increase prediction accuracy, the model integrates imaging and clinical data. It optimizes the surgical procedure, helps doctors create customized treatment regimens, lessens radiation exposure and problems, and lets doctors more thoroughly evaluate patients' risk stratification.\u003c/p\u003e"},{"header":"2 OBJECTS AND METHODS","content":"\u003cp\u003e\u003cstrong\u003e2.1 Research Objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur center\u0026apos;s intraoperative DSA image retention system and electronic medical record system were used to retrospectively gather clinical, imaging, and surgical data from patients who had IVCF removal over a long period of time, from June 2022 to June 2024. This included information on age, gender, whether there was a combination of bone fracture, hypertension, diabetes mellitus, coronary artery disease, cerebral infarction, type of filter, placement route, placement duration, IVCF placement plane, IVC width, tilt angle, IVC angle, and so forth. IVC width, common iliac vein-IVC angle, tilt angle, etc. \u0026nbsp;This study concentrated on patients with IVCF placement via the femoral vein with a prolonged retrieval window because there were few and statistically insignificant cases of IVCF placement via the jugular vein at our center. Patients who satisfied the following inclusion criteria were the study\u0026apos;s subjects. According to local regulations, written informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article. The research was approved by the Ethics Committee of The Third Hospital of Hebei Medical University. Ethics approval Number: KS-2025-254, Approval time: April 30th, 2025. We confirmed that all methods were performed in accordance with the relevant guidelines and regulations. This study is in line with the declaration of Holsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1.1 Criteria for Inclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;1) Long recovery window IVCF is the type of IVCF\u003c/p\u003e\n\u003cp\u003e2) Femoral vein is the placement route\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;3) Age (18 years or older but under 90 years)\u003c/p\u003e\n\u003cp\u003e4) Full clinical and imaging information\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;2.1.2 Criteria for Exclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;1) The patient is older than 90 years\u003c/p\u003e\n\u003cp\u003e2) The jugular vein is the placement pathway\u003c/p\u003e\n\u003cp\u003e3) The IVCF type is either permanent or short-time window IVCF\u003c/p\u003e\n\u003cp\u003e4) Basic clinical or imaging data is absent or incomplete\u003c/p\u003e\n\u003cp\u003eA total of 372 cases\u0026mdash;185 (49.7%) of Denali IVCF, 87 (23.3%) of Octoparms IVCF, and 100 (20.0%) of Option IVCF\u0026mdash;met the aforementioned inclusion and exclusion criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1.3 An Explanation of IVCF Removal Challenges\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Regarding IVCF retrieval challenges, the medical community cannot agree. A research by Dinglasan \u003csup\u003e[11]\u0026nbsp;\u003c/sup\u003eet al. identified a number of situations where IVCF retrieval is challenging, including: \u0026nbsp;1) major complications during or after retrieval, such as avulsion of the IVC wall, perforation bleeding, or severe stenotic occlusion; 2) serious complications resulting from the IVCF itself, such as breakage, displacement, or perforation of the IVC due to preoperative IVCF displacement; and 3) clinician application of a grasper to grasp the filter for more than five minutes or multiple unsuccessful attempts at the standard retrieval method, necessitating the use of an advanced technique for retrieval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1.4 Grouping of Studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Every patient in this experimental investigation was divided into two groups based on whether or not improved recovery strategies were applied during IVCF removal. Of these, 39 patients used enhanced recovery techniques to remove their IVCF, whereas 333 patients underwent a traditional treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Data Collecting for Surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe tilt angle of the angiography machine, the angle between the IVC and the common iliac vein, and the IVC width in the plane of IVCF implantation were all measured using the measurement equipment and data gathered from the computer attached to the digital angiography machine. \u0026nbsp;The angle between the axis of the IVC where the filter is located and the axis of the IVCF is known as the tilt angle (Figure 1A), the angle between the axis of the inferior IVC and the axis of the common iliac vein is known as the common iliac vein-IVC angle (Figure 1B), and the width of the IVC in the plane of IVCF placement is known as the IVC width (Figure 1C).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Methods of Statistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;For statistical processing, R software version 4.3.3 and SPSS version 26.0 were used. \u0026nbsp;The t-test was utilized to compare groups, and measurement data was presented as mean \u0026plusmn; standard deviation(\u003cimg width=\"23\" height=\"27\" src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1753288243.gif\" alt=\"image\"\u003es). \u0026nbsp;The chi-square test or Fisher\u0026apos;s exact probability method was used to compare groups, and count and grading data were presented as rates or percentages. \u0026nbsp;A multifactorial logistic regression model was constructed and a column-line graph was created in order to predict independent risk factors for IVCF removal difficulty. All of the patients involved in this experimental investigation were randomly assigned to a training group and a validation set in a 7:3 ratio. The model\u0026apos;s validity and reliability were tested by the calibration curve and decision curve (DCA), while the predictive efficacy was measured by the area under the curve (AUC) of the subjects\u0026apos; operating characteristics (ROC).\u003c/p\u003e"},{"header":"3 RESUITS","content":"\u003cp\u003e\u003cstrong\u003e3.1 Comparison of Baseline Characteristics of Training Set and Validation Set\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe randomly divided the patients included in this experimental study into training set and validation set according to the ratio of 7:3. Among them, there were 260 in the training set and 112 in the validation set. The general information of the two groups of patients was included in the statistical study, P\u0026gt;0.05, and the differences in the baseline characteristics of the two groups were not statistically significant (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Analysis of univariates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The statistical study included the training set of 260 patients, 27 of whom underwent advanced rehabilitation treatments. \u0026nbsp; Six P\u0026lt;0.2 for age, placement path, retention time, IVC width, tilt angle, and iliac vein-IVC angle were identified as prospective risk factors for challenging IVCF retrieval in the one-way logistic regression, which comprised potentially relevant parameters (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Regression Using Multiple Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 3 shows that the four items of IVCF inclination angle, retention time, common iliac vein-IVC angle, and IVC width had P \u0026lt; 0.05, which were the independent risk factors for the difficulty of filter removal. These six risk factors were further included in the multifactorial analysis from the study\u0026apos;s univariate analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Line Chart Plotting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs seen in Figure 2, a risk prediction model for filter removal difficulties was built using the four independent factors examined by multifactor logistic regression analysis. \u0026nbsp;Each independent risk factor was given a Nomo score, which was then added up depending on the patient\u0026apos;s clinical parameters. The patient\u0026apos;s overall score indicated the likelihood that they would need the advanced retrieval approach. \u0026nbsp;After that, the model was validated internally. To do this, the sampling on the column-line plots was repeated 1000 times using the Bootstrap method in the R software. The column line plot projected a high degree of agreement between the incidence of utilizing the enhanced recall approach and the actual incidence, demonstrating good predictive ability, since the calibration curve was near the ideal curve (Figure 3/Figure 4/Figure 5).\u003c/p\u003e"},{"header":"4 DISCUSSION","content":"\u003cp\u003eClinical practice has largely\u003csup\u003e[12]\u003c/sup\u003e accepted the implantation of an IVCF to prevent deadly PE caused to DVT. \u0026nbsp;Studies conducted both domestically and abroad over the past ten years have demonstrated that the IVCF is a reasonably safe medical technology that can offer patients substantial advantages. \u0026nbsp;The device\u0026apos;s ability to successfully capture displaced thrombus has greatly decreased the morbidity and mortality of fatal PE.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA thorough retrospective review conducted overseas, however, revealed that while IVCFs are successful in preventing PE, the risk of several complications\u0026mdash;such as thrombosis, migration, vascular wall penetration, and fracture\u0026mdash;increases significantly after more than 30 days following implantation\u003csup\u003e[13]\u003c/sup\u003e. \u0026nbsp;According to a review by Hadied et al., a longer IVCF stay is linked to a higher risk of complications\u003csup\u003e[14]\u003c/sup\u003e and could have an impact on the patient\u0026apos;s quality of life and prognosis. \u0026nbsp;As a result, doctors should place a high priority on promptly retrieving IVCFs. IVCF removal is a difficult process; failure rates for traditional surgical excision range from 7% to 28%\u003csup\u003e[15,16]\u003c/sup\u003e. \u0026nbsp;Our center\u0026apos;s data revealed that the conventional retrieval failure rate was 10.48%, which is below the global average but still requires attention. \u0026nbsp;In order to increase the success rate and guarantee that patients receive safe and efficient treatment, we are striving to refine the extraction procedure.\u003c/p\u003e\n\u003cp\u003eWe employed the more sophisticated advanced technique of advanced IVCF retrieval in order to overcome the difficulty of longer window IVCFs that are not retrievable through standard processes. \u0026nbsp;The utilization of the Loop approach was the main focus of the current investigation. According to Desai et al.\u003csup\u003e[17]\u003c/sup\u003e, the success rate for retrieving a traditional process was approximately 82%, while the enhanced technique had an 18% success rate. \u0026nbsp;Our facility achieved a high success rate of 99% (only one instance was not retrieved) and the overall success rate rose to 98% with the upgraded technique. This illustrates the Loop technique\u0026apos;s enormous potential and offers insightful and useful lessons for therapeutic treatment going forward. \u0026nbsp;Research on risk factors for challenging or even challenging IVCF retrieval is currently lacking, nevertheless. \u0026nbsp;There aren\u0026apos;t many well-known risk scoring systems to direct the risk stratification of IVCF recall issues. \u0026nbsp;Analyzing the clinical risk factors of IVCF retrieval difficulties, investigating and developing an efficient clinical risk prediction model\u003csup\u003e[18]\u003c/sup\u003e, giving doctors a more precise and trustworthy foundation for advice, improving the IVCF retrieval protocol, and lowering patient costs and radiation exposure duration were the objectives of this study.\u003c/p\u003e\n\u003cp\u003eThe current study\u0026apos;s findings demonstrated that the difficulty of removing IVCF with a long retrieval window was influenced by independent risk factors, including IVCF tilt angle, retention time, common iliac vein-IVC angle, and IVC breadth.\u003c/p\u003e\n\u003cp\u003eIVCF tilt that resulted in wall adherence of the retrieval hook was a substantial risk factor for retrieval difficulty, and the angle of IVCF tilt was significantly linked with IVCF retrieval difficulty\u003csup\u003e[19]\u003c/sup\u003e. Steyerberg et al. showed that IVCF tilt more than 15\u0026deg; and IVCF retrieval hook embedding in the venous wall were both significant indicators of IVCF retrieval difficulties\u003csup\u003e[20]\u003c/sup\u003e. Recovery risk rose 2.38 times when IVCF tilted between 5 and 15 degrees\u003csup\u003e[11]\u003c/sup\u003e. The IVCF was prone to tilting when the angle between its long axis and the long axis of the IVC was more than 20\u0026deg;. This led to the recovery hook becoming fastened to the wall and made recovery more challenging\u003csup\u003e[21]\u003c/sup\u003e. This is in line with what we found. \u0026nbsp;According to pertinent international research, IVCF tilt may be produced by IVC tortuosity, IVCF placement position, placement technique, and extra-luminal compression brought on by abdominal tumors, aortic aneurysms, and other conditions\u003csup\u003e[22]\u003c/sup\u003e. \u0026nbsp;This implies that we should precisely understand the indications for IVCF installation and adhere to the operating standards.\u003c/p\u003e\n\u003cp\u003eLong-term IVCF retention may result in endothelial hyperplasia and the IVCF support foot adhering tightly to the IVC, making removal more challenging. \u0026nbsp; According to a study conducted abroad, the endothelium started to proliferate seven days after the IVCF was placed\u003csup\u003e[23,24]\u003c/sup\u003e, thickened significantly and fixed the IVCF after two weeks\u003csup\u003e[25,26]\u003c/sup\u003e, stabilized endothelial proliferation after four to eight weeks, and the IVCF was essentially fused with the endothelium within forty to sixty days. 30 \u0026nbsp;As a result, prompt removal of the long-retained IVCF is essential.\u003csup\u003e[27]\u003c/sup\u003e The average time for successful IVCF removal was 58.7 days, while the average time for failure was 95.4 days, according to Marquess et al. \u0026nbsp;In order to guarantee prompt IVCF removal once the risk of fatal PE has decreased, doctors should maintain continuous communication with patients who have IVCF placement.\u003c/p\u003e\n\u003cp\u003eIVCF removal becomes more challenging when the common iliac vein-IVC pinch angle is greater. The longer the delivery sheath\u0026apos;s axis is parallel to the IVC\u0026apos;s long axis, the closer the IVCF\u0026apos;s head end is to the lumen\u0026apos;s center upon release, and the less likely wall apposition is, the smaller the patient\u0026apos;s common iliac vein-IVC angle is. According to Oseph et al.\u003csup\u003e[28]\u003c/sup\u003e, the higher the IVCF is at the time of release, the less likely it is to tilt. This is because the closer the plane of placement is to the top at release, the more parallel the delivery sheath is with the long axis of the IVC, the smaller the angle of deflection that is created, and the lower the bending degree of the delivery sheath during placement. This is because the transport sheath\u0026apos;s curvature during placement decreases as the release plane gets closer to the top. This is because the transport sheath is more parallel to the long axis of the IVC and the deflection angle is smaller.\u003c/p\u003e\n\u003cp\u003eIVC width and IVCF retrieval difficulties are significantly correlated: the wider the IVC, the more challenging it is to recover the IVCF, which is in line with the findings of the Laidlaw et al. study\u003csup\u003e[29]\u003c/sup\u003e. \u0026nbsp;Additionally, it has been observed that thinner IVCs have a higher probability of tilting the recovery hook against the wall, which makes IVCF retrieval more challenging\u003csup\u003e[10]\u003c/sup\u003e. \u0026nbsp;Therefore, more research is still needed to confirm the impact of IVC width on IVCF retrieval.\u003c/p\u003e\n\u003cp\u003eBy combining several variables to precisely forecast medical outcomes or evaluate the impact of interventions, clinical risk prediction models support clinical decision-making\u003csup\u003e[30]\u003c/sup\u003e. \u0026nbsp;Physicians can swiftly select the most effective examination or treatment plan by using column line graphs, which can clearly show the relationship between predictors and outcomes\u003csup\u003e[20]\u003c/sup\u003e. Four important risk factors (IVCF tilt angle, retention time, common iliac vein-IVC pinch angle, and IVC width) were included in this study\u0026apos;s risk prediction model for IVCF removal difficulty with a prolonged retrieval window. A clinical risk prediction model was developed and validated, and it was displayed using a column-line diagram to help clinicians determine the likelihood that removing an IVCF would be difficult. In order to give clinicians an easy-to-use risk assessment tool, this study creatively integrated risk factor analysis with the development of risk prediction models. \u0026nbsp;The findings have both theoretical and clinical significance, contributing to better patient outcomes and quality of life as well as the effectiveness and success of filter removal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to clinical and equipment limitations, the study only examined left-right tilting of the filter and did not investigate the effect of anterior-posterior tilting on IVCF removal. Even though the risk prediction model showed good predictive performance, it was only internally validated and lacked external data as a single-center study; future external validation using multiple samples and multicenter trials will be required to draw more thorough and reliable conclusions.\u003c/p\u003e"},{"header":"5 CONCLUSION","content":"\u003cp\u003eIVC width, retention duration, common iliac vein-IVC angle, and IVCF tilt angle are all independent risk variables for IVCF removal difficulties during extended retrieval windows. The difficulty of IVCF removal is greatly increased when these risk factors are present, so clinicians should take precautions to lower the procedure's risk. Convenient for clinical use, the clinical risk prediction model developed in this study using the aforementioned independent risk indicators in conjunction with a column-line diagram can forecast the likelihood of IVCF removal difficulty. The methodology is effective and helps doctors make decisions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.1717%;\"\u003e\n \u003cp\u003eName\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.8283%;\"\u003e\n \u003cp\u003eVariable assignment and description\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.1717%;\"\u003e\n \u003cp\u003eIVCF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.8283%;\"\u003e\n \u003cp\u003einferior vena cava filter\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.1717%;\"\u003e\n \u003cp\u003eDVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.8283%;\"\u003e\n \u003cp\u003edeep vein thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.1717%;\"\u003e\n \u003cp\u003ePE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.8283%;\"\u003e\n \u003cp\u003epulmonary embolisms\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.1717%;\"\u003e\n \u003cp\u003eIVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.8283%;\"\u003e\n \u003cp\u003einferior vena cava\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.1717%;\"\u003e\n \u003cp\u003eROC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.8283%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReceiver Operating Characteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.1717%;\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.8283%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArea Under Curve\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.1717%;\"\u003e\n \u003cp\u003eDCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.8283%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecision Curve Analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request. If you need to ask us for the data of this study, please contact YanRong Zhang, Email: [email protected] or Fengkai Wang, Email: [email protected].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article. The research was approved by the Ethics Committee of The Third Hospital of Hebei Medical University. Ethics approval Number: KS-2025-254, Approval time: April 30th, 2025.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003cstrong\u003enformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has obtained the informed consent of the participating patients.Informed consent was obtained from all subjects and/or their legal guardian(s).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; original draft: Qianqian Jiang, Yu Huang, Lijian Wang, Tianyi Zhu, Chong Li, Jiatao Li\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; review \u0026amp; editing: Yaqi Wang, Ruijiao Gao, Liang Li, Xiangdong Liu, YunSong Li, Yanrong Zhang, FengKai Wang\u003c/p\u003e\n\u003cp\u003eData curation: Qianqian Jiang, Yu Huang\u003c/p\u003e\n\u003cp\u003eProject administration: Yanrong Zhang, FengKai Wang\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical Science Research Project of Hebei(Analysis of Risk Factors Associated with Difficulty in Removing Long-term Recycled Window Filters and Establishment of a Clinical Prediction Model).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eImberti D, Dentali F, Ageno W, et al. Evidence and clinical judgment: vena cava filters[J]. Thrombosis and haemostasis, 2014, 111(4): 618-624.\u003c/li\u003e\n \u003cli\u003eChen Z, Zhang FX, Li XQ, et al. Guidelines for clinical application of vena cava filters[J]. Chinese Journal of Practical Surgery, 2019, 39(7): 651-654.\u003c/li\u003e\n \u003cli\u003eSamama CM, Afshari A. European guidelines on perioperative venous thromboembolism prophylaxis[J]. European Journal of Anaesthesiology EJA, 2018, 35(2): 73-76.\u003c/li\u003e\n \u003cli\u003eStevens H, Tran H. Update on diagnosis and anticoagulant therapy for venous thromboembolism[J]. Internal Medicine Journal, 2018, 48(10): 1175-1184.\u003c/li\u003e\n \u003cli\u003eAvgerinos ED, Bath J, Stevens J, et al. Technical and patient-related characteristics associated with challenging retrieval of inferior vena cava filters[J]. European Journal of Vascular and Endovascular Surgery, 2013, 46(3): 353-359.\u003c/li\u003e\n \u003cli\u003eVon Stempel C, Hague J, Brookes J. Excimer laser assisted complex inferior vena cava filter retrieval: a single institution\u0026apos;s experience over 6 years[J]. Clinical Radiology, 2019, 74(1): 79. e15-79. e20.\u003c/li\u003e\n \u003cli\u003eCrumley KD, Hyatt E, Kalva SP, et al. Factors affecting inferior vena cava filter retrieval: a review[J]. Vascular and Endovascular Surgery, 2019, 53(3): 224-229.\u003c/li\u003e\n \u003cli\u003eIliescu B, Haskal ZJ. Advanced techniques for removal of retrievable inferior vena cava filters[J]. Cardiovascular and interventional radiology, 2012, 35: 741-750.\u003c/li\u003e\n \u003cli\u003eClements W. Inferior vena cava filters in the asymptomatic chronically occluded cava: to remove or not remove?[J]. CardioVascular and Interven- tional Radiology, 2019, 42(2): 165-168.\u003c/li\u003e\n \u003cli\u003eClements W, Moriarty HK, Paul E, et al. Stratification of pre-procedure risk factors associated with difficult-to-remove inferior vena cava(IVC) filters: a 6-year retrospective analysis at a tertiary center[J]. Cardio Vascular and Interventional Radiology, 2020, 43(2): 238-245.\u003c/li\u003e\n \u003cli\u003eDinglasan LAV, Oh JC, Schmitt JE, et al. Complicated inferior vena cava filter retrievals: associated factors identified at preretrieval CT[J]. Radiology, 2013, 266(1): 347-354.\u003c/li\u003e\n \u003cli\u003eWang SL, Lloyd AJ. Clinical review: inferior vena cava filters in the age of patient-centered outcomes[J]. Annals of medicine, 2013, 45(7): 474- 481.\u003c/li\u003e\n \u003cli\u003eAngel L F, Tapson V, Galgon RE, et al. Systematic review of the use of retrievable inferior vena cava filters[J]. Journal of Vascular and Interventional Radiology, 2011, 22(11): 1522-1530. e3.\u003c/li\u003e\n \u003cli\u003eHadied MO, Hieromnimon M, Kapke J, et al. Caval pseudoaneurysms following complex inferior vena cava filter removal: Clinical significance and patient outcomes[J]. Vascular, 2021, 29(4): 624-629.\u003c/li\u003e\n \u003cli\u003eWang H, Liu Z, Zhu X, et al. Retroperitoneal laparoscopic-assisted retrieval of wall-penetrating inferior vena cava filter after endovascular techniques failed: an initial clinical outcome[J]. Vascular and Endova- scular Surgery, 2021, 55(7): 706-711.\u003c/li\u003e\n \u003cli\u003eChen G, Shen Y, Chen YH, et al. Analysis of the causes of difficult retrievable filters and removal strategies[J]. Chinese Family Medicine, 2019, 17(7): 1222-1224.\u003c/li\u003e\n \u003cli\u003eDesai KR, Laws JL, Salem R, et al. Defining prolonged dwell time: when are advanced inferior vena cava filter retrieval techniques necessary? An analysis in 762 procedures[J]. Circulation: Cardiovascular Interventions, 2017, 10(6): e003957.\u003c/li\u003e\n \u003cli\u003eFK C. A critical appraisal of logistic regression-based nomograms, artifi- cial neural networks, classification and regression-tree models, look-up tables and risk-group stratification models for prostate cancer[J]. BJU Int., 2007, 99: 794-800.\u003c/li\u003e\n \u003cli\u003eKleedehn M, Moore K, Longo K, et al. An analysis of factors associated with increased fluoroscopy time or the need for complex techniques at IVC filter retrieval[J]. European Radiology, 2019, 29: 1931-1938.\u003c/li\u003e\n \u003cli\u003eSteyerberg EW, Vergouwe Y. Towards better clinical prediction models: seven steps for development and an ABCD for validation[J]. European heart journal, 2014, 35(29): 1925-1931.\u003c/li\u003e\n \u003cli\u003eNosaka M, Ishida Y, Kuninaka Y, et al. The application of autophagy to thrombus age estimation in murine deep vein thrombosis model[J]. International Journal of Legal Medicine, 2020, 134: 1061-1066.\u003c/li\u003e\n \u003cli\u003eSemaan D, Esq MR, Burgin A, et al. Inferior vena cava filter tilt and its future clinical implications: a community based practices experience[J]. Journal of Vascular and Interventional Radiology, 2013, 24(4): S166.\u003c/li\u003e\n \u003cli\u003eHunter DW, Lund G, Rysavy JA, et al. Retrieving the Amplatz retrievable vena cava filter[J]. Cardiovascular and Interventional Radio- logy, 1987, 10: 32-36.\u003c/li\u003e\n \u003cli\u003eGuan HT, Tong XQ, Wang J, et al. 24. Animal experimental study of a new type of retrievable inferior vena cava filter[J]. China Interventional Imaging and Therapy, 2010(3): 313-316.\u003c/li\u003e\n \u003cli\u003eNeuerburg J, G\u0026uuml;nther RW, Rassmussen E, et al. New retrievable percu- taneous vena cava filter: experimental in vitro and in vivo evaluation[J]. Cardiovascular and interventional radiology, 1993, 16: 224-229.\u003c/li\u003e\n \u003cli\u003eGreenfield LJ, Proctor MC, James EA, et al. Staging of fixation and retrievability of Greenfield filters[J]. Journal of vascular surgery, 1994, 20(5): 744-750.\u003c/li\u003e\n \u003cli\u003eMarquess JS, Burke CT, Beecham AH, et al. Factors associated with failed retrieval of the G\u0026uuml;nther Tulip inferior vena cava filter[J]. Journal of Vascular and Interventional Radiology, 2008, 19(9): 1321-1327.\u003c/li\u003e\n \u003cli\u003eJoseph AS, Lopera JE. Digital radiograph(DR) guided bedside IVC filter placements in patients with intracranial pressure monitors[J]. Journal of Interventional Medicine, 2021, 4(4): 208-211.\u003c/li\u003e\n \u003cli\u003eLaidlaw GL, Chick JFB, Ingraham CR, et al. Inferior vena cava filter tilting between placement and retrieval is associated with caval diameter and need for complex retrieval techniques[J]. Clinical Imaging, 2021, 80: 243-248.\u003c/li\u003e\n \u003cli\u003eAdams ST, Leveson SH. Clinical prediction rules[J]. Bmj, 2012, 344.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Inferior Vena Cava Filter, Risk Factors, Inferior Vena Cava, Clinical Prediction Modelt, Deep vein thrombosis","lastPublishedDoi":"10.21203/rs.3.rs-6941709/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6941709/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To investigate the clinically significant risk factors for problematic inferior vena cava filter (IVCF) removal with a long retrieval window and to create a clinical model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Patients who had IVCF removal and IVCF type with lengthy recovery window IVCF in the Third Hospital of Hebei Medical University's vascular surgery department between June 2022 and June 2024 were gathered with routine anticoagulation prior to surgery. A total of 372 patients—211 men and 161 women—with ages ranging from 18 to 87 years and a mean age of 58.47 ± 13.32 years were enrolled in the study. Of them, 185 had Denali IVCF, 87 Octoparms IVCF, and 100 Option IVCF. In order to determine the independent risk factors for the difficulty of removing IVCFs from a long recovery window, univariate and multivariate logistic regression analysis were used. A columnar graphical model was built to internally validate the predictive efficacy and calibration of the model using the area under the curve (AUC) of the subject's work characteristics (ROC), calibration curve, and decision curve (DCA). The independent risk factors were examined using univariate and multivariate logistic regression analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA risk prediction model for difficulty in removing IVCF was constructed after a multifactorial logistic regression analysis revealed that IVCF tilt angle, retention time, common iliac vein-IVC angle, and IVC width were independent risk factors for difficulty in removing IVCF with a prolonged retrieval window. Internal validation of the model revealed that the calibration curves were near the ideal curves; the ROC curve for the training set had an AUC of 0956, and the ROC curve for the validation set had an AUC of 0.985.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The clinical risk prediction model built using these risk factors is useful in predicting the difficulty of removing IVCFs with prolonged retrieval windows and has clinical guidance value. IVCF tilt angle, retention time, common iliac vein-IVC angle, and IVC width are independent risk factors for difficulty in removing IVCFs with prolonged retrieval windows.\u003c/p\u003e","manuscriptTitle":"Developing a clinical prediction model and analyzing risk factors linked to the challenge of eliminating extended recovery window filters","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-25 11:34:04","doi":"10.21203/rs.3.rs-6941709/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33ac2f2f-9956-4242-8fb6-401b07927f42","owner":[],"postedDate":"July 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-26T03:23:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-25 11:34:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6941709","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6941709","identity":"rs-6941709","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}