Helling Thomas S, Kaswan Sumesh, Miller S Lee, Tretter James F
Department of Surgery, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania, USA.
J Trauma. 2009 Dec;67(6):1293-6. doi: 10.1097/TA.0b013e3181b0637a.
BACKGROUND: The use of permanent inferior vena cava filters (IVCFs) offers protection against pulmonary embolism (PE) but increases the long-term risk of deep vein thrombosis (DVT) and does not affect long-term mortality. The use of retrievable IVCFs in trauma patients offers the dual advantage of protection against PE during the risk period and the option of filter removal thus avoiding complications of DVT. Despite the safety of removal, it is likely that many of these retrievable filters are not removed. METHODS: This was a retrospective, single-center, observational cohort study at a rural level I trauma center. We sought to investigate the number of patients and the circumstances under which retrievable IVCFs were placed and removed. RESULTS: During a 4-year period, 3,455 trauma patients were admitted and 125 patients had retrievable IVCFs placed (71 therapeutic and 54 prophylactic). The most common indications were traumatic brain and spinal cord injuries (66%). During in-hospital filter use, there were 36 new incidences (29%) of PE (1) and DVT (35). Nine patients died before removal. In 40 patients (32%), removal was attempted, and 32 (26%) retrievable IVCFs were successfully removed and in most patients (76%) within 180 days of insertion. Seventeen patients were transferred out of the area for extended care and lost to follow-up. In 55 patients, the filters were not removed. In 20 patients, the surgeon decided against removal. Thirty patients were transferred to extended care or rehabilitation within the community, but they did not return for removal. Thus, of 108/125 patients with follow-up, 76 patients (70%) did not have their IVCFs removed, and 50 patients did not have their IVCFs removed because of the choice of the surgeon, extended care, or rehabilitation. CONCLUSIONS: The use of retrievable IVCFs, when necessary, produced predictable protection against PE and DVT complications. Despite the opportunity for removal, most patients, in fact, did not have their filters removed, even when posthospital care could be tracked. The practices of the surgeon, the transfer to extended-care facilities, near or far, and the reluctance to remove long-standing IVCFs contributed to the high-retention rate.
背景：使用永久性下腔静脉滤器（IVCF）可预防肺栓塞（PE），但会增加深静脉血栓形成（DVT）的长期风险，且不影响长期死亡率。在创伤患者中使用可回收IVCF具有双重优势，即在风险期内可预防PE，并且可以选择取出滤器，从而避免DVT并发症。尽管取出滤器是安全的，但很可能许多可回收滤器并未被取出。 方法：这是一项在农村一级创伤中心进行的回顾性、单中心观察性队列研究。我们试图调查放置和取出可回收IVCF的患者数量及情况。 结果：在4年期间，共收治3455例创伤患者，其中125例患者放置了可回收IVCF（71例为治疗性，54例为预防性）。最常见的适应证是创伤性脑损伤和脊髓损伤（66%）。在住院期间使用滤器时，有36例新发生的PE（1例）和DVT（35例）。9例患者在取出滤器前死亡。40例患者（32%）尝试取出滤器，32例（26%）可回收IVCF成功取出，且大多数患者（76%）在植入后180天内取出。17例患者转至外地接受长期护理并失访。55例患者的滤器未取出。20例患者中，外科医生决定不取出滤器。30例患者转至社区内的长期护理机构或康复机构，但未返回取出滤器。因此，在125例有随访的患者中，108例患者中有76例（70%）未取出IVCF，50例患者未取出IVCF是因为外科医生的选择、长期护理或康复。 结论：必要时使用可回收IVCF可对PE和DVT并发症产生可预测的预防作用。尽管有取出滤器的机会，但实际上大多数患者即使在可以追踪出院后护理的情况下也未取出滤器。外科医生的做法、转至远近不同的长期护理机构以及不愿取出长期存在的IVCF导致了高保留率。
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