Berczi V, Bottomley J R, Thomas S M, Taneja S, Gaines P A, Cleveland T J
Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK.
Cardiovasc Intervent Radiol. 2007 Sep-Oct;30(5):820-7. doi: 10.1007/s00270-007-9153-z. Epub 2007 Sep 1.
Thromboembolic disease produces a considerable disease burden, with death from pulmonary embolism in the UK alone estimated at 30,000-40,000 per year. Whilst it is unproven whether filters actually improve longevity, the morbidity and mortality associated with thromboembolic disease in the presence of contraindications to anticoagulation is high. Thus complications associated with filter insertion, and whilst they remain in situ, must be balanced against the alternatives. Permanent filters remain in situ for the remainder of the patient's life and any complications from the filters are of significant concern. Filters that are not permanent are therefore attractive in these circumstances. Retrievable filters, to avoid or decrease long-term filter complications, appear to be a significant advance in the prevention of pulmonary embolism. In this review, we discuss the safety and effectiveness of both permanent and retrievable filters as well as the retrievability of retrievable inferior vena cava (IVC) filters, to explore whether the use of permanent IVC filters can be abandoned in favor of retrievable filters. Currently four types of retrievable filters are available: the Recovery filter (Bard Peripheral Vascular, Tempe, AZ, USA), the Günther Tulip filter (Cook, Bloomington, IN, USA), the OptEase Filter (Cordis, Roden, The Netherlands), and the ALN filter (ALN Implants Chirurgicaux, Ghisonaccia, France). Efficacy and safety data for retrievable filters are as yet based on small series, with a total number of fewer than 1,000 insertions, and follow-up is mostly short term. Current long-term data are poor and insufficient to warrant the long-term implantation of these devices into humans. The case of fractured wire from a Recovery filter that migrated to the heart causing pericardial tamponade requiring open heart surgery is a reminder that any new endovascular device remaining in situ in the long term may produce unexpected problems. We should also bear in mind that the data on permanent filters are much more robust, with reports on over 9,500 cases with follow-up of up to 8 years. The original implantation time of 10-14 days has been extended to more than 100 days as the mean implantation time with some of the filter types. Follow-up (preferably prospective) is necessary for all retrievable filters, whether or not they are retrieved. Until these data become available we should restrict ourselves to the present indications of permanent and retrievable filters. If long-term follow-up data on larger numbers of cases confirm the initial data that retrievable filters are as safe and effective as permanent filters, the use of the retrievable filters is likely to expand.
血栓栓塞性疾病造成了相当大的疾病负担，仅在英国，每年估计有30000 - 40000人死于肺栓塞。虽然滤器是否真的能延长寿命尚无定论，但在存在抗凝禁忌的情况下，与血栓栓塞性疾病相关的发病率和死亡率很高。因此，必须在滤器植入相关并发症以及滤器留置期间的并发症与其他治疗选择之间进行权衡。永久性滤器会在患者余生中一直留置体内，滤器引发的任何并发症都备受关注。因此，在这种情况下，非永久性滤器很有吸引力。可回收滤器为避免或减少长期滤器并发症，在预防肺栓塞方面似乎是一项重大进展。在本综述中，我们讨论了永久性和可回收滤器的安全性和有效性，以及可回收下腔静脉（IVC）滤器的可回收性，以探讨是否可以放弃使用永久性IVC滤器而改用可回收滤器。目前有四种类型的可回收滤器：Recovery滤器（美国亚利桑那州坦佩市巴德外周血管公司）、Günther Tulip滤器（美国印第安纳州布卢明顿市库克公司）、OptEase滤器（荷兰罗登市科迪斯公司）和ALN滤器（法国吉索尼阿西亚市ALN植入物外科公司）。可回收滤器的疗效和安全性数据目前基于小样本系列，植入总数少于1000例，且随访大多为短期。目前的长期数据不足，不足以证明将这些装置长期植入人体的合理性。有一例Recovery滤器的金属丝断裂并迁移至心脏，导致心包填塞，需进行心脏直视手术，这提醒我们，任何长期留置体内的新型血管内装置都可能产生意想不到的问题。我们还应牢记，永久性滤器的数据更为可靠，有超过9500例的报告，随访时间长达8年。某些滤器类型的平均植入时间已将最初的10 - 14天延长至100多天。对于所有可回收滤器，无论是否回收，都需要进行随访（最好是前瞻性随访）。在获得这些数据之前，我们应遵循永久性和可回收滤器目前的适应证。如果大量病例的长期随访数据证实了最初的数据，即可回收滤器与永久性滤器一样安全有效，那么可回收滤器的使用可能会扩大。
