Millward S F, Bhargava A, Aquino J, Peterson R A, Veinot J P, Bormanis J, Wells P S
Department of Diagnostic Imaging, University of Ottawa, Ottawa Hospital, Ontario, Canada.
J Vasc Interv Radiol. 2000 Jan;11(1):75-82. doi: 10.1016/s1051-0443(07)61286-x.
The Günther Tulip filter is a permanent filter that has a hook to permit retrieval. The authors report their preliminary clinical evaluation of the filter with regard to feasibility and safety of retrieval.
Nine men and six women who ranged in age from 17 to 79 years (mean, 51 years) underwent treatment with use of the Günther Tulip filter. Patients judged to require caval interruption for < 14 days were selected to receive the filter and retrieval was planned for all patients. Indications for filter placement were: recent pulmonary embolism (PE) or proximal deep vein thrombosis (DVT) with a contraindication to anticoagulation (11 patients), massive PE treated with thrombolytic therapy (one patient), PE with heparin-induced thrombocytopenia (one patient), and prophylaxis after major trauma (two patients). Patients were followed for inferior vena cava (IVC) thrombosis, bleeding, and recurrent DVT or PE.
In all nine patients in whom it was attempted, the filter was successfully snared and retrieved via a jugular approach. The mean implantation period was 8.6 days (range, 5-13 days). Retrieval required 2.2-13 minutes (mean 5.3 minutes) of fluoroscopy. No caval injuries occurred as a result of retrieval. All retrieved filters had strands of organized thrombus on the filter struts. The patients were followed for 52-285 days (mean, 115 days) after retrieval. One patient developed a recurrent DVT 230 days after retrieval. No other patients developed a recurrent DVT and no patients developed IVC thrombosis, bleeding, or PE. Six filters were not retrieved: five because of an ongoing contraindication to anticoagulation and one because the patient died of causes unrelated to the filter.
This preliminary study confirms the feasibility and safety of retrieval of the Günther Tulip filter up to 13 days after implantation.
Günther Tulip滤器是一种带有挂钩以便取出的永久性滤器。作者报告了他们对该滤器取出的可行性和安全性的初步临床评估。
9名男性和6名女性，年龄在17至79岁之间（平均51岁），接受了Günther Tulip滤器治疗。被判定需要下腔静脉阻断小于14天的患者被选择接受滤器植入，并且计划对所有患者进行取出操作。滤器置入的适应证为：近期肺栓塞（PE）或近端深静脉血栓形成（DVT）且有抗凝禁忌证（11例患者）、接受溶栓治疗的大面积PE（1例患者）、伴有肝素诱导的血小板减少症的PE（1例患者）以及重大创伤后的预防（2例患者）。对患者进行随访，观察下腔静脉（IVC）血栓形成、出血以及复发性DVT或PE情况。
在所有尝试取出滤器的9例患者中，均通过颈静脉途径成功圈套并取出滤器。平均植入期为8.6天（范围5 - 13天）。取出操作需要2.2 - 13分钟（平均5.3分钟）的透视时间。取出过程中未发生腔静脉损伤。所有取出的滤器在滤器支柱上均有条索状机化血栓。取出后对患者随访52 - 285天（平均115天）。1例患者在取出后230天发生复发性DVT。没有其他患者发生复发性DVT，也没有患者发生IVC血栓形成、出血或PE。6个滤器未取出：5个是因为持续存在抗凝禁忌证，1个是因为患者死于与滤器无关的原因。
这项初步研究证实了Günther Tulip滤器在植入后13天内取出的可行性和安全性。
