Background and Aims Inferior vena cava filters (IVCF) are widely used in the prevention of fatal pulmonary embolism (PE) and removed by interventional technique, and surgical removal may be considered for filters that are irretrievable by endovascular approach or exceed the time window for retrieval. This study was performed to evaluate the safety and feasibility of open surgery for removal of the IVCF.Methods The clinical data of 27 patients who underwent open surgery for filter retrieval after IVCF placement from February 2019 to August 2022 in the Vascular Surgery Department of Beijing Jishuitan Hospital was retrospectively analyzed. In all patients, the median number of attempts of interventional filter retrieval was 1 (1-2) before open surgery.Results All filters were removed and the technical success rate was 100%. The median time for filter implantation was 20 (5-48) months. There were 8 cases (29.6%) of Aegisy filter, 1 case (3.7%) of Denali filter, 10 cases (37.0%) of Cordis filter, 1 case (3.7%) of Simon filter, 3 cases (11.1%) of Celect filter, and 4 cases (14.8%) of Tulip filter, respectively. The filter was located in the suprarenal inferior vena cava in 1 case (3.7%), in the retrohepatic inferior vena cava in 1 case (3.7%), and in the subrenal inferior vena cava in 25 cases (92.6%). During the operation, a suture line was placed at the retrieval hook, the filter was removed by direct clamping the retrieval hook without occlusion of the inferior vena cava, and a purse-string suture was performed after removal in 2 cases (7.4%); the filter was directly retrieved to the vascular sheath followed by closure without occlusion of the inferior vena cava in 2 cases (7.4%); the filter was removed by incision of the anterior wall of the inferior vena cava followed by continuous suture of the vessel after blocking the blood flow of the bilateral renal veins and the inferior vena cava at distal and proximal ends of the filter in 1 case (3.7%), blocking the blood flow of the distal inferior vena cava, the first hepatic portal and the second hepatic portal in 1 case (3.7%), and blocking the blood flow of the inferior vena cava at the distal end of the filter in 21 cases (77.8%). The average operative time was (224.15±23.85) min. No deep venous thrombosis or symptomatic PE, no cardiopulmonary complications, and wound infection during the perioperative period. Abdominal pain with bloody gastric juice occurred in 1 case (3.7%), and hematuria occurred in 1 case (3.7%), which were relieved after symptomatic treatment. The average hemoglobin level was (128.59±15.05) g/L before surgery, and (110.56±22.15) g/L after surgery. Six patients (22.2%) received 400 mL of red blood cell suspension transfusion after surgery. No fatal hemorrhage or shock occurred. The median length of postoperative hospital stay was 9 (8-12) d.Conclusion Although open surgical filter removal is difficult and technically complex, filter removal is safe and feasible. Sufficient CT evaluation of the position of the filter and its hook before surgery and using appropriate surgical approach, with specific surgical skills, the safety and success rate of open surgery can be greatly improved.