Cahn M D, Rohrer M J, Martella M B, Cutler B S
University of Massachusetts Memorial Medical Center, Division of Vascular Surgery, Worcester, MA 01655, USA.
J Vasc Surg. 2001 Nov;34(5):820-5. doi: 10.1067/mva.2001.118801.
The long-term results of Greenfield inferior vena cava (IVC) filter placement have been well documented in adults; however, similar data do not exist for pediatric patients. The potential for growth and the increased life expectancy in younger patients may contribute to a difference in the natural history of filters placed in children. The objective of this study was to evaluate the long-term outcome of pediatric patients with IVC filters.
At the University of Massachusetts Memorial Medical Center, medical records and radiographs of patients 18 years old or younger at the time of IVC filter placement were reviewed. Follow-up data were obtained by interview, physical examination, and venous duplex ultrasound scanning.
A total of 15 IVC filters were placed in children 18 years old or younger between 1983 and 1999. In 10 patients the indications for IVC filter placement were lower-extremity deep venous thrombosis (DVT) and/or pulmonary embolism. In five patients, prophylactic filters were placed in the absence of DVT because of a high risk for the development of pulmonary embolism. Surgical exposure of the right internal jugular vein was used to place the first eight filters. The remainder were inserted percutaneously through the right internal jugular vein or the right common femoral vein. There were no complications or mortality related to filter insertion. Follow-up of the surviving 14 patients ranged from 19 months to 16 years. During long-term follow-up, no patient had a pulmonary embolus. Of the nine patients who had lower-extremity DVT, three developed mild common femoral venous reflux documented by duplex scan. Of the five patients who had prophylactic filters, four had no symptoms or duplex evidence of reflux. The other patient, who was paraplegic, had bilateral leg edema but no venous varicosities and no reflux on duplex scan 11 years after filter placement. No patient in either group had chronic venous obstruction.
In long-term follow-up there were no instances of pulmonary embolism, IVC thrombosis, significant postphlebitic symptoms, or significant filter migration among 14 pediatric patients with Greenfield IVC filters. This suggests a safety profile and efficacy similar to that seen in adults.
格林菲尔德下腔静脉（IVC）滤器置入术在成人中的长期效果已有充分记录；然而，儿科患者的类似数据并不存在。年轻患者的生长潜力和预期寿命增加可能导致儿童置入滤器的自然病程有所不同。本研究的目的是评估儿科IVC滤器置入患者的长期结局。
在马萨诸塞大学纪念医学中心，回顾了IVC滤器置入时年龄在18岁及以下患者的病历和X光片。通过访谈、体格检查和静脉双功超声扫描获得随访数据。
1983年至1999年间，共为18岁及以下儿童置入了15个IVC滤器。10例患者置入IVC滤器的指征为下肢深静脉血栓形成（DVT）和/或肺栓塞。5例患者因发生肺栓塞的高风险，在无DVT的情况下置入了预防性滤器。最初的8个滤器通过右颈内静脉手术暴露置入。其余滤器通过右颈内静脉或右股总静脉经皮插入。没有与滤器置入相关的并发症或死亡。14例存活患者的随访时间为从对19个月至16年。在长期随访期间，没有患者发生肺栓塞。9例患有下肢DVT的患者中，3例经双功扫描显示出现轻度股总静脉反流。5例置入预防性滤器的患者中，4例没有症状或双功扫描显示无反流。另1例截瘫患者在滤器置入11年后出现双侧腿部水肿，但无静脉曲张，双功扫描也无反流。两组患者均无慢性静脉阻塞。
在长期随访中，14例置入格林菲尔德IVC滤器的儿科患者中没有发生肺栓塞、IVC血栓形成、明显的血栓后症状或明显的滤器移位情况。这表明其安全性和有效性与成人相似。
