Background and Aims Inferior vena cava filters (IVCF) effectively prevent fatal pulmonary embolism (PE) and are widely used in clinical practice. They are suitable for patients with recurrent PE and those with lower extremity deep vein thrombosis (DVT) who have contraindications to anticoagulation during the perioperative period requiring mechanical thrombectomy or catheter-directed thrombolysis. Once the thrombus has resolved or stabilized and the PE risk has decreased, experts widely accept that the IVCF should be retrieved. Most retrievable IVCFs can be removed through endovascular surgery. However, retrieval becomes problematic when the retrieval hook of a conical filter penetrates the inferior vena cava (IVC) wall or when the spindle filter exceeds the retrieval time window. Forcibly retrieving the filter endovascularly may damage the IVC, posing a life-threatening risk to the patient. Leaving the filter in place permanently can result in complications such as filter fracture, perforation, IVC obstruction, and the need for long-term anticoagulation, leading to patient anxiety. These patients may opt for open abdominal surgery to retrieve the filter, which has shown satisfactory results. This study was performed to further explore the methods, safety, efficacy, and short- to mid-term outcomes of open surgery for retrieving IVCFs that are difficult to remove through the endovascular procedure.Methods The data of 36 patients who underwent open surgery to retrieve IVCFs that were difficult to remove through endovascular procedures between January 2020 and December 2023 were retrospectively collected. The types of filters, retrieval success rate, and postoperative complications, as well as the changes in blood parameters and anxiety status after surgery were analyzed.Results Among the 36 patients, 30 cases (83.3%) involved spindle-shaped filters, and 6 cases (16.7%) involved conical filters; two filters (5.6%) were located in the suprarenal IVC, while 34 filters (94.4%) were located in the infrarenal IVC. The median retention time for the filters was 15 (5-41) months. All 36 filters were successfully retrieved, with a retrieval rate of 100%, and no perioperative deaths occurred. Compared to preoperative levels, postoperative hemoglobin levels decreased, while D-dimer and aspartate aminotransferase levels increased (all P<0.05), but no safety risks were observed. Both the positive rate of anxiety and the Hamilton Anxiety Rating Scale scores were significantly reduced after surgery (both P<0.05). There was one case (2.8%) of respiratory failure and one case (2.8%) of pericaval hematoma, with no cases of symptomatic PE. During the 3-6 month follow-up, no recurrence or worsening of lower extremity DVT was observed, IVC occlusion occurred in one case (2.8%), incisional hernia occurred in two cases (5.6%), and three cases (8.3%) had minor residual filter fragments, with no cases of symptomatic PE.Conclusions For the retrieval of IVCFs that are difficult to remove through the endovascular method, open surgery is safe and allows for successful filter retrieval without symptomatic PE or new lower extremity DVT. Additionally, it significantly improves patients' anxiety.