Gunther Tulip retrievable filter: Why, when and how?

Nonpermanent inferior vena cava (IVC) filters can be subdivided into tempor ary and retrievable filters.(1) Temporary filters are attached to a cathete r or guide wire. They have been extensively used in Europe, mainly for the prevention of pulmonary embolism (PE) during thrombolytic treatment for low er extremity deep vein thrombosis (DVT).(2) However, the reported rate of r ecurrent PE in patients protected with a temporary filter appears to be sim ilar, or even higher, than that seen in North American studies of thromboly tic treatment of DVT when no filter was used.(2,3) Results obtained with te mporary filters in other clinical situations have also been somewhat discou raging.(1,2) Consequently, research efforts in North America with nonperman ent filters appear to have shifted predominantly to the study of retrievabl e filters.(4) Retrievable filters, such as the Gunther Tulip filter (Willia m Cook Europe, Bjaeverskov, Denmark) (Fig. 1), are permanent filters with a design feature (usually a hook that can be snared) to permit retrieval. Th ey have an advantage over temporary filters in that they can be either left in place permanently or retrieved, whichever is most appropriate for a giv en patient.(4) The Gunther Tulip filter is currently the only approved device fi om this v ersatile new class of retrievable filters. In this article, I hope to offer some practical points on why, when and how the device should be used.