Usoh Fred, Hingorani Anil, Ascher Enrico, Shiferson Alexander, Tran Victor, Marks Natalie, Jacob Theresa
Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn, New York 11219, USA.
Ann Vasc Surg. 2009 May-Jun;23(3):350-4. doi: 10.1016/j.avsg.2008.08.012. Epub 2008 Sep 21.
The short-term effectiveness and safety placement of superior vena cava (SVC) filter in the treatment of upper extremity deep venous thrombosis in patients with contraindication to anticoagulation have been well documented. However, as opposed to the numerous reported experiences with inferior vena cava filter placement and its complications, there has been no documented long-term follow-up on SVC filter placement. We, therefore, reviewed our experience with SVC filter placement. A retrospective review was performed of the 154 cases of patients who underwent SVC filter placement between January 1994 and August 2005 at our institution. Seven additional patients had unsuccessful SVC filter placement due to widespread deep venous thrombosis. The data were evaluated for both insertion complications (pneumothorax, hemorrhage, filter misplacement) and long-term complications (pulmonary embolism, migration, caval occlusion). The follow-up included review of serial chest radiographs to evaluate for filter migration in patients who lived at least 60 days after filter insertion and had chest radiography performed (n = 40), patients' charts, clinic visits, and telephone contacts, hospital databases, city death records, and national databases. There were 69 males and 85 females with a mean age of 73.6 years (range, 16-96 years; +/-15.3 [SD] years). Follow-up ranged from 1 day to 3750 days (256.3 +/- 576 days [mean +/- SD]) and 5 patients were lost to follow-up. Of the 154 patients, 58 survived longer than 60 days with mean follow-up of 628.4 days. All SVC filters (TrapEase, n = 38; Greenfield, n = 116) were successfully deployed in the 154 patients. During the follow-up, 114 (74.0% mortality) of the patients died of chronic illness or from cancer complications. There were three cases of pericardial tamponade (1.9%), and one case of misplaced filter in innominate vein. There were no known cases of symptomatic pulmonary embolism, caval occlusion, pneumothorax, or filter migration. SVC filter placement is associated with a low incidence of complications with long-term follow-up. These data help to reaffirm the safety and effectiveness of SVC filter placement. However, SVC perforation in young males remains a significant issue.
上腔静脉（SVC）滤器在抗凝治疗禁忌的上肢深静脉血栓形成患者中的短期有效性和安全性已得到充分证明。然而，与众多关于下腔静脉滤器置入及其并发症的报道经验不同，目前尚无关于SVC滤器置入的长期随访记录。因此，我们回顾了我们在SVC滤器置入方面的经验。对1994年1月至2005年8月在我们机构接受SVC滤器置入的154例患者进行了回顾性研究。另外7例患者因广泛的深静脉血栓形成导致SVC滤器置入失败。对数据进行了插入并发症（气胸、出血、滤器误置）和长期并发症（肺栓塞、移位、腔静脉阻塞）的评估。随访包括对连续胸部X线片的复查，以评估滤器置入后至少存活60天且进行了胸部X线检查的患者（n = 40）的滤器移位情况、患者病历、门诊就诊情况、电话联系、医院数据库、城市死亡记录和国家数据库。共有69例男性和85例女性，平均年龄73.6岁（范围16 - 96岁；±15.3[标准差]岁）。随访时间从1天到3750天（256.3±576天[平均±标准差]），5例患者失访。154例患者中，58例存活超过60天，平均随访628.4天。所有SVC滤器（TrapEase，n = 38；Greenfield，n = 116）均成功植入154例患者体内。随访期间，1,14例（死亡率74.0%）患者死于慢性病或癌症并发症。有3例心包填塞（1.9%），1例滤器误置于无名静脉。没有已知的有症状肺栓塞、腔静脉阻塞、气胸或滤器移位病例。SVC滤器置入的并发症发生率较低，长期随访结果证实了其安全性和有效性。然而，年轻男性的SVC穿孔仍是一个重要问题。
