Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3651, Stanford, CA 94305-5642, USA.
Cardiovasc Intervent Radiol. 2012 Jun;35(3):588-97. doi: 10.1007/s00270-011-0175-1. Epub 2011 May 12.
We evaluated the safety and effectiveness of alternative endovascular methods to retrieve embedded optional and permanent filters in order to manage or reduce risk of long-term complications from implantation. Histologic tissue analysis was performed to elucidate the pathologic effects of chronic filter implantation.
We studied the safety and effectiveness of alternative endovascular methods for removing embedded inferior vena cava (IVC) filters in 10 consecutive patients over 12 months. Indications for retrieval were symptomatic chronic IVC occlusion, caval and aortic perforation, and/or acute PE (pulmonary embolism) from filter-related thrombus. Retrieval was also performed to reduce risk of complications from long-term filter implantation and to eliminate the need for lifelong anticoagulation. All retrieved specimens were sent for histologic analysis.
Retrieval was successful in all 10 patients. Filter types and implantation times were as follows: one Venatech (1,495 days), one Simon-Nitinol (1,485 days), one Optease (300 days), one G2 (416 days), five Günther-Tulip (GTF; mean 606 days, range 154-1,010 days), and one Celect (124 days). There were no procedural complications or adverse events at a mean follow-up of 304 days after removal (range 196-529 days). Histology revealed scant native intima surrounded by a predominance of neointimal hyperplasia and dense fibrosis in all specimens. Histologic evidence of photothermal tissue ablation was confirmed in three laser-treated specimens.
Complex retrieval methods can now be used in select patients to safely remove embedded optional and permanent IVC filters previously considered irretrievable. Neointimal hyperplasia and dense fibrosis are the major components that must be separated to achieve successful retrieval of chronic filter implants.
为了管理或降低植入后长期并发症的风险，我们评估了替代血管内方法取出嵌入式可选和永久性过滤器的安全性和有效性。进行组织学分析以阐明慢性过滤器植入的病理影响。
我们研究了 10 例连续患者在 12 个月内使用替代血管内方法取出嵌入式下腔静脉（IVC）过滤器的安全性和有效性。检索的适应证为慢性 IVC 闭塞、腔静脉和主动脉穿孔和/或来自过滤器相关血栓的急性 PE（肺栓塞）。检索还用于降低长期过滤器植入的并发症风险，并消除对终身抗凝的需求。所有取出的标本均进行组织学分析。
10 例患者均成功取出过滤器。过滤器类型和植入时间如下：一个 Venatech（1495 天），一个 Simon-Nitinol（1485 天），一个 Optease（300 天），一个 G2（416 天），五个 Günther-Tulip（GTF；平均 606 天，范围 154-1010 天）和一个 Celect（124 天）。在取出后平均 304 天（范围 196-529 天）的随访中，没有发生程序并发症或不良事件。所有标本均显示少量固有内膜，周围为新生内膜过度增生和致密纤维化。在三个激光治疗标本中证实了光热组织消融的组织学证据。
现在可以在选择的患者中使用复杂的检索方法，安全地取出先前认为不可检索的嵌入式可选和永久性 IVC 过滤器。必须分离新生内膜过度增生和致密纤维化，以成功取出慢性过滤器植入物。
