Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
J Vasc Surg. 2011 Dec;54(6 Suppl):34S-8S.e1. doi: 10.1016/j.jvs.2011.05.094. Epub 2011 Aug 6.
Most studies have shown that the rate of inferior vena cava filter (IVCF) retrieval rarely exceeds 30%. A review of practices in our own institution revealed similar results (18%). Within the last year, few centers have demonstrated improved retrieval rates. Our hypothesis was that developing a dedicated program would improve IVCF retrieval. We report the results of an ongoing study following the development of this program.
This is a cohort of nontrauma consecutive patients who had an IVCF placed by the vascular service over a 12-month period (January 2010-January 2011) and were followed prospectively. A dedicated nurse practitioner was responsible in developing a database, maintaining contact with all the patients, and ensuring that arrangements were made for retrieval when indications for IVCF protection were no longer present. Demographics, indication for filter placement, timing to filter retrieval, and complications during placement and retrieval were prospectively collected. Retrieval rate was compared to the baseline institution data.
During the study period, 42 patients had an IVCF placed. There were 27 men and 15 women with a mean age of 58 (25 to 88 years old). Two patients were excluded (one due to mortality and one had multiple filters) leaving 40 patients in the study. Indications for IVCF placement were absolute in 23 of 40 patients (58%), relative in 10 of 40 patients (25%), while seven patients (17%) had an IVCF placed for prophylaxis as they were considered high risk for pulmonary embolism (PE) and could not receive any chemical regimen. During follow-up, five filters were converted to permanent. Therefore, retrieval was successful in 19 of 22 patients with an 86% success rate and no complications. Median time to retrieval was 21 days ranging from 4 to 140 days. Retrieval rate for IVCFs designated as temporary at the time of placement was 70% (19 of 27), which was significantly higher compared to our baseline data of 18% (P < .001).
Initial data show that a dedicated program that closely monitors patients with temporary IVCFs for ongoing need of filter prophylaxis can result in high retrieval rates. The endurance and long-term success of such a program needs to be further validated.
大多数研究表明，下腔静脉滤器（IVCF）取出率很少超过 30%。对我们机构实践的回顾显示了类似的结果（18%）。在过去的一年中，少数中心已经证明了取出率的提高。我们的假设是，制定专门的计划将提高 IVCF 的取出率。我们报告了在该计划制定后进行的一项正在进行的研究的结果。
这是一组连续的非创伤性患者，他们在 12 个月期间（2010 年 1 月至 2011 年 1 月）由血管科放置了 IVCF，并进行了前瞻性随访。一名专门的执业护士负责开发数据库，与所有患者保持联系，并确保在不再需要 IVCF 保护的情况下为取出做好安排。前瞻性收集了人口统计学资料、滤器放置的适应证、滤器取出的时间以及放置和取出过程中的并发症。将取出率与基线机构数据进行比较。
在研究期间，42 例患者放置了 IVCF。27 例为男性，15 例为女性，平均年龄 58 岁（25 至 88 岁）。有 2 例患者被排除（1 例因死亡，1 例有多个滤器），因此 40 例患者纳入研究。40 例患者中，23 例（58%）为绝对适应证，10 例（25%）为相对适应证，7 例（17%）因被认为有发生肺栓塞（PE）的高风险而预防性放置 IVCF，且不能接受任何化学治疗方案。在随访期间，5 个滤器转换为永久性。因此，22 例患者中有 19 例（86%）成功取出，无并发症。中位取出时间为 21 天，范围为 4 至 140 天。放置时被指定为临时的 IVCF 的取出率为 70%（19 例中有 19 例），明显高于我们 18%的基线数据（P<.001）。
初步数据表明，对临时 IVCF 患者进行持续监测，以确定是否需要持续滤器预防的专门计划可以导致高取出率。这种计划的耐久性和长期成功需要进一步验证。
