Cízek V, Kucera D, Válka M, Bartos P, Maderic D, Pleva M
Vaskulární centrum, Vítkovická nemocnice a.s., Ostrava.
Vnitr Lek. 2009 Mar;55(3):267-71.
Pulmonary embolism (PE) is the most serious sign of venous thromboembolism and the 3rd most frequent cause of cardiovascular death. Therapy with anticoagulants represents, among other measures, the mainstay of PE treatment. However, anticoagulant therapy does not prevent recurrence of pulmonary embolism in 3-20% of patients. Most frequently, the source of pulmonary embolism is in venous circulation of lower limbs and pelvis. Interception of the inferior vena cava, originally surgical, later using inferior vena cava filters, is used as a preventive measure. Indications and contraindications of inferior vena cava filters have been redressed and modified several times; the paper provides their list. Older filters used to be retained within the inferior vena cava (so called permanent filters). This was one of the causes of relatively high incidence of complications related to the use of these filters, particularly venous thromboses, as confirmed by so far the only randomised study PREPIC. Consequently, retrievable filters that are currently preferred have been developed. The authors also provide an overview of studies in progress, describe the process of implantation and describe own patient group.
肺栓塞(PE)是静脉血栓栓塞最严重的表现,也是心血管死亡的第三大常见原因。抗凝治疗是肺栓塞治疗的主要手段之一,除此之外还有其他措施。然而,抗凝治疗并不能预防3%-20%的患者出现肺栓塞复发。肺栓塞最常见的来源是下肢和骨盆的静脉循环。最初通过手术、后来使用下腔静脉滤器来拦截下腔静脉,作为一种预防措施。下腔静脉滤器的适应证和禁忌证已经多次修订和调整;本文列出了这些内容。过去使用的旧滤器会留在下腔静脉内(即所谓的永久性滤器)。这是这些滤器使用相关并发症发生率相对较高的原因之一,尤其是静脉血栓形成,这一点已被迄今为止唯一的随机研究PREPIC所证实。因此,目前更常用的可回收滤器已经研发出来。作者还概述了正在进行的研究,描述了植入过程并介绍了自己的患者群体。