Rosenthal David, Wellons Eric D, Lai Kin Man, Bikk Andras, Henderson Vernon J
Department of Vascular Surgery, Atlanta Medical Center, Atlanta, GA 30312, USA.
Ann Vasc Surg. 2006 Jan;20(1):157-65. doi: 10.1007/s10016-005-9390-z.
Anticoagulation is the accepted therapy for patients with thromboembolic disease. When contraindications to anticoagulant therapy are present, however, interruption of the inferior vena cava (IVC) may prevent pulmonary embolism (PE). The objective of this study was to report our early technical and clinical results with retrievable IVC filters (IVCFs) for the prevention of PE. One hundred and twenty-seven multitrauma patients between December 1, 2002, and December 31, 2004, underwent placement of Gunther-Tulip (n = 49), Recovery (n = 41), or OptEase (n = 37) retrievable IVCFs under real-time intravascular ultrasound (IVUS) guidance. All patients had abdominal X-rays to verify filter location. Prior to IVCF retrieval, all patients underwent femoral vein color flow ultrasonography to rule out deep vein thrombosis (DVT) and vena-cavography to assess the IVCF for trapped emboli, filter tilt, or retrained thrombus. Thirty-nine patients died of their injuries; no deaths were related to IVCF placement. One PE occurred during follow-up after filter retrieval, and two femoral vein insertion-site DVTs occurred. One hundred twenty (94.4%) of IVCFs were placed without complication at the L2-3 level, as verified by abdominal X-rays. Filter-related complications included three groin hematomas (2.9%) and three IVCFs misplaced in the right iliac vein early in our experience (2.3%); these filters were uneventfully retrieved and replaced in the IVC within 24 hr. Sixty-six patients underwent uneventful retrieval of IVCFs after DVT or PE anticoagulation prophylaxis was initiated. Forty-five IVCFs were not removed: 41 due to contraindications due to anticoagulation and four because of trapped thrombus within the filter. The role of retrievable IVCFs continues to evolve, but in this study of 127 patients, prophylactic temporary IVCF placement was simple and safe, prevented fatal PE, and served as an effective "bridge" to anticoagulation. Further investigation of this bedside IVUS technique and the role of temporary IVCFs in different patient populations is warranted.
抗凝治疗是血栓栓塞性疾病患者公认的治疗方法。然而，当存在抗凝治疗的禁忌证时，下腔静脉（IVC）中断术可预防肺栓塞（PE）。本研究的目的是报告我们使用可回收下腔静脉滤器（IVCFs）预防PE的早期技术和临床结果。在2002年12月1日至2004年12月31日期间，127例多发伤患者在实时血管内超声（IVUS）引导下植入了Gunther-Tulip（n = 49）、Recovery（n = 41）或OptEase（n = 37）可回收IVCFs。所有患者均进行腹部X线检查以核实滤器位置。在取出IVCF之前，所有患者均接受股静脉彩色血流超声检查以排除深静脉血栓形成（DVT），并进行腔静脉造影以评估IVCF是否捕获栓子、滤器倾斜或残留血栓。39例患者因伤死亡；无死亡与IVCF植入相关。在滤器取出后的随访期间发生1例PE，2例股静脉穿刺部位DVT。经腹部X线检查证实，120例（94.4%）IVCFs在L2-3水平植入且无并发症。与滤器相关的并发症包括3例腹股沟血肿（2.9%）和在我们早期经验中有3例IVCFs误置于右髂静脉（2.3%）；这些滤器在24小时内顺利取出并重新植入IVC。66例患者在开始进行DVT或PE抗凝预防后顺利取出IVCFs。45例IVCFs未取出：41例因抗凝禁忌证，4例因滤器内捕获血栓。可回收IVCFs的作用仍在不断演变，但在这项对127例患者的研究中，预防性临时植入IVCFs简单安全，可预防致命性PE，并作为抗凝治疗的有效“桥梁”。有必要进一步研究这种床旁IVUS技术以及临时IVCFs在不同患者群体中的作用。
