Blebea J, Wilson R, Waybill P, Neumyer M M, Blebea J S, Anderson K M, Atnip R G
Departments of Surgery and Radiology, Pennsylvania State University College of Medicine, Hershey, PA, USA.
J Vasc Surg. 1999 Nov;30(5):821-8. doi: 10.1016/s0741-5214(99)70006-6.
A large multicenter study has recently questioned the overall clinical efficacy of vena caval filters, especially when inserted prophylactically, because of the subsequent development of deep venous thrombosis (DVT) at the insertion site. We examined the incidence of this complication with newer, smaller diameter percutaneous devices.
We reviewed our vascular surgery and interventional radiology clinical registries to identify patients in whom a femoral percutaneous vena caval filter had been placed from 1993 to 1998. This list was cross referenced with patients who had undergone lower extremity venous ultrasound scan examinations for the diagnosis of DVT in the vascular laboratory within a 60-day period before and after the insertion of the filter device.
A total of 35 patients during this 5-year period had timely follow-up venous duplex scan studies performed. The indications for filter placement were DVT in 16 patients (46%), pulmonary embolus in 13 patients (37%), DVT and pulmonary embolus in three patients (9%), and prophylactically in three patients (9%) at high risk for thromboembolization. Of the patients with documented thromboembolic events, 91% (29 of 32) had contraindications to anticoagulation therapy, and the remaining 9% (3 of 32) represented failure of anticoagulation therapy. A Greenfield filter was used in 13 patients (37%), a Simon Nitinol filter was used in 11 patients (31%), and a VenaTech filter was used in nine patients (26%). The other two patients (6%) had a Bird's Nest filter inserted. At a mean follow-up period of 12 +/- 2 days (median, 6 days), there was a 40% (14 of 35) incidence of proximal DVT in venous segments without evidence of thrombus before filter insertion. The majority (71%; 10 of 14) occurred in the common femoral vein, with three located in the superficial femoral vein and one in the external iliac vein. The lowest incidence of DVT was seen with the Greenfield and Bird's Nest filters as compared with the smaller Simon Nitinol and VenaTech filters (20% vs 55%; P < .05). The highest incidence of thrombosis occurred in patients with pre-insertion pulmonary emboli (50%; 8 of 16) as compared with those patients with DVT (38%; 6 of 16) and prophylactic insertion (0%; 0 of 3). However, the subgroups were too small to attain statistical significance.
There is a continuing and significant incidence of new DVT development ipsilateral to the percutaneous femoral insertion site of vena caval filters. The smaller diameter filters are not associated with a lower incidence of femoral thrombosis.
最近一项大型多中心研究对腔静脉滤器的整体临床疗效提出质疑，尤其是预防性置入时，原因是置入部位随后会发生深静脉血栓形成（DVT）。我们使用更新的、直径更小的经皮装置检查了这种并发症的发生率。
我们查阅了血管外科和介入放射科的临床登记资料，以确定1993年至1998年期间接受股静脉经皮腔静脉滤器置入的患者。该名单与在滤器装置置入前后60天内在血管实验室接受下肢静脉超声扫描检查以诊断DVT的患者进行交叉对照。
在这5年期间，共有35例患者进行了及时的随访静脉双功扫描研究。滤器置入的指征为：16例患者（46%）为DVT，13例患者（37%）为肺栓塞，3例患者（9%）为DVT合并肺栓塞，3例患者（9%）为血栓栓塞高危患者预防性置入。在有记录的血栓栓塞事件患者中，91%（32例中的29例）有抗凝治疗的禁忌证，其余9%（32例中的3例）为抗凝治疗失败。13例患者（37%）使用了Greenfield滤器，11例患者（31%）使用了Simon镍钛合金滤器，9例患者（26%）使用了VenaTech滤器。另外2例患者（6%）置入了鸟巢式滤器。平均随访期为12±2天（中位数为6天），在滤器置入前无血栓证据的静脉段中，近端DVT的发生率为40%（35例中的14例）。大多数（71%；14例中的10例）发生在股总静脉，3例位于股浅静脉，1例位于髂外静脉。与较小的Simon镍钛合金滤器和VenaTech滤器相比，Greenfield滤器和鸟巢式滤器的DVT发生率最低（20%对55%；P<.05）。与DVT患者（38%；16例中的6例）和预防性置入患者（0%；3例中的0例）相比，置入前有肺栓塞的患者血栓形成发生率最高（50%；16例中的8例）。然而，各亚组样本量太小，未达到统计学显著性。
腔静脉滤器经皮股静脉置入部位同侧新发生DVT的发生率持续且显著。直径较小的滤器与股静脉血栓形成发生率较低无关。
