Wojcik R, Cipolle M D, Fearen I, Jaffe J, Newcomb J, Pasquale M D
Department of Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania 18105-1556, USA.
J Trauma. 2000 Nov;49(5):839-43. doi: 10.1097/00005373-200011000-00008.
Venous thromboembolism (VTE) is an important complication in blunt trauma patients. At our Level I trauma center, we had a deep venous thrombosis (DVT) rate of 3.2% from 1993 to 1997 despite an aggressive VTE prophylaxis program. During this time period, we placed vena caval filters (VCF) for both traditional and prophylactic indications. This project was developed to establish a VCF registry for trauma patients to determine the long-term complications of VCF placement.
A letter was sent to all trauma patients who had a VCF placed from 1993 through 1997. Patients were asked to return for a history and physical examination to detect signs and symptoms related to VTE, a duplex ultrasound of the inferior vena cava, and a plain abdominal radiograph to determine filter migration.
There were 191 VCFs inserted in our trauma population from 1993 to 1997. There were 105 patients (75 male and 30 female) available for evaluation, with a mean follow-up of 28.9 months. Forty-one VCFs were placed in patients with DVT or pulmonary embolism, and 64 were placed in patients for prophylactic indications as per the guidelines developed by the Eastern Association for the Surgery of Trauma. There were no clinically identifiable complications related to insertion of the VCF. There were no pulmonary embolisms detected after VCF insertion. In follow-up, only one filter (0.95%) migrated, and this was minimal (1 cm cephalad). One (0.95%) vena cava was occluded, based on duplex ultrasonography, and 11 patients (10.4%) had signs or symptoms of leg swelling after hospital discharge. Twenty eight (44%) of the 64 patients with prophylactic VCFs developed a DVT after filter placement.
VCFs placed in trauma patients have acceptable short- and long-term complication rates. Consideration should be given to prophylactic VCF placement in patients at high risk for VTE. Randomized controlled trials are needed to evaluate whether VCF insertion increases the risk for subsequent DVT.
静脉血栓栓塞症（VTE）是钝性创伤患者的一种重要并发症。在我们的一级创伤中心，尽管实施了积极的VTE预防方案，但1993年至1997年期间深静脉血栓形成（DVT）发生率仍为3.2%。在此期间，我们因传统适应证和预防性适应证放置了腔静脉滤器（VCF）。开展本项目旨在建立创伤患者VCF登记册，以确定VCF置入的长期并发症。
向1993年至1997年期间所有置入VCF的创伤患者发送一封信函。要求患者复诊以获取病史并进行体格检查，以检测与VTE相关的体征和症状，进行下腔静脉双功超声检查，并拍摄腹部平片以确定滤器移位情况。
1993年至1997年期间，我们的创伤患者群体中共置入191个VCF。有105例患者（75例男性和30例女性）可供评估，平均随访28.9个月。41个VCF置入DVT或肺栓塞患者，64个VCF根据东部创伤外科学会制定的指南置入预防性适应证患者。未发现与VCF置入相关可临床识别的并发症。VCF置入后未检测到肺栓塞。随访中，仅1个滤器（0.95%）发生移位，且移位程度极小（向上1 cm）。根据双功超声检查，1个（0.95%）下腔静脉发生闭塞，11例患者（10.4%）出院后出现腿部肿胀的体征或症状。64例预防性置入VCF的患者中有28例（44%）在滤器置入后发生DVT。
创伤患者置入的VCF短期和长期并发症发生率均可接受。对于VTE高危患者应考虑预防性置入VCF。需要进行随机对照试验以评估VCF置入是否会增加后续DVT的风险。
