Page Y, Decousus H, Comtet C, Mismetti P, Tardy B, Bertrand J C
Service d'urgences et réanimation médicales, hôpital Bellevue, Saint-Etienne.
Arch Mal Coeur Vaiss. 1991 Nov;84(11 Suppl):1747-54.
Clinical indications of vena cava interruption are reviewed. During the last few years pulmonary embolism frequency remained high and many new percutaneous vena caval filters became available. These facts probably explain the increasing use of these filters reaching about 10,000 filters each year in France. Existing data show that: embolic risk with antithrombotic agents is less than 5%, probably not far greater than embolic risk with cava filters (about 2%); complications encountered with the filters are caval thrombosis in 8%, and more or less than 4% other major complications; there is no controlled study comparing antithrombotic treatment associated with caval filters to antithrombotic treatment alone; there is no controlled study comparing new cava filters among them or to the Greenfield filter; economical implications of caval filters are mostly unknown. The only admitted indications of vena cava interruption, in case of proximal venous thrombosis, are contraindications to anticoagulation. In other situations no data allow to recommend a cava filter; indication will be discussed on a case by case basis. Prospective controlled studies are greatly encouraged.
回顾了腔静脉阻断的临床指征。在过去几年中，肺栓塞的发生率一直居高不下，并且有许多新型经皮腔静脉滤器可供使用。这些事实可能解释了这些滤器使用量的增加，在法国每年使用量达到约10000个。现有数据表明：使用抗血栓药物的栓塞风险低于5%，可能并不比腔静脉滤器的栓塞风险（约2%）高很多；滤器相关并发症包括8%的腔静脉血栓形成，以及或多或少4%的其他严重并发症；没有对照研究比较联合腔静脉滤器的抗血栓治疗与单纯抗血栓治疗；没有对照研究比较新型腔静脉滤器之间或与格林菲尔德滤器的差异；腔静脉滤器的经济影响大多未知。在近端静脉血栓形成的情况下，腔静脉阻断唯一公认的指征是抗凝的禁忌证。在其他情况下，没有数据支持推荐使用腔静脉滤器；将根据具体情况讨论适应证。强烈鼓励开展前瞻性对照研究。
