Spaniolas Konstantinos, Velmahos George C, Kwolek Christopher, Gervasini Alice, De Moya Marc, Alam Hasan B
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
World J Surg. 2008 Jul;32(7):1438-43. doi: 10.1007/s00268-008-9523-y.
Bedside placement of removable inferior vena cava filters (RVCF) is increasingly used in critically injured patients. The need for fluoroscopic equipment and specialized intensive care unit beds presents major challenges. Intravascular ultrasound (IVUS) eliminates such problems. The objective of the present study was to analyze the safety and feasibility of IVUS-guided bedside RVCF placement in critically injured patients.
Between October 2004 and July 2006 47 IVUS-guided RVCF were placed at the bedside. Medical and trauma registry records were reviewed. Primary outcome was RVCF-related complications.
The mean patient age was 41 +/- 19 years, and the mean Injury Severity Score was 30 +/- 12. The right common femoral vein was chosen as the site of access in 40 patients, and the left common femoral vein was the access site in 7 patients. The insertion was performed 3.7 +/- 2.5 days after admission. Four patients (8.5%) developed common femoral deep vein thrombosis (DVT) and three (6%) developed a peripheral pulmonary embolism (PE). Complications related to technique were recorded in two patients (4%) and included one misplacement and one access site bleeding with no further associated morbidity. Five patients died during the hospital stay from issues unrelated to RVCF. Forty-one patients were eligible for follow-up. Removal of RVCF was offered only to 8 patients and was performed successfully in 4 (10%) at a mean of 130 days (range: 44-183 days).
In this study IVUS-guided bedside placement of RVCF was feasible but was also associated with complications. Follow-up was poor, and the rate of removal disappointingly low, underscoring the need for further exploration of the role of RVCF.
可移除式下腔静脉滤器（RVCF）的床旁放置在重症创伤患者中应用日益广泛。使用荧光透视设备和专门的重症监护病床存在重大挑战。血管内超声（IVUS）可消除此类问题。本研究的目的是分析在重症创伤患者中，IVUS引导下RVCF床旁放置的安全性和可行性。
2004年10月至2006年7月期间，在床旁进行了47例IVUS引导下的RVCF放置。回顾了医疗和创伤登记记录。主要结局是与RVCF相关的并发症。
患者平均年龄为41±19岁，平均损伤严重度评分是30±12。40例患者选择右股总静脉作为穿刺部位，7例患者选择左股总静脉作为穿刺部位。放置操作在入院后3.7±2.5天进行。4例患者（8.5%）发生股总深静脉血栓形成（DVT），3例患者（6%）发生外周肺栓塞（PE）。2例患者（4%）记录到与操作技术相关的并发症，包括1例放置错误和1例穿刺部位出血，无进一步相关的发病情况。5例患者住院期间死于与RVCF无关的问题。41例患者符合随访条件。仅8例患者接受了RVCF取出，其中4例（10%）成功取出，平均时间为130天（范围：44 - 183天）。
在本研究中，IVUS引导下RVCF床旁放置是可行的，但也伴有并发症。随访情况不佳，取出率低得令人失望，这凸显了进一步探索RVCF作用的必要性。
