Wood Emily A, Malgor Rafael D, Gasparis Antonios P, Labropoulos Nicos
Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
Phlebology. 2014 Aug;29(7):471-5. doi: 10.1177/0268355513491723. Epub 2013 May 28.
Perforation of the inferior vena cava by filters struts is a known complication. The goal of our review is to assess the impact of inferior vena cava perforation by filters based on an open, voluntary national database.
We reviewed 3311 adverse events of inferior vena cava filters reported in Manufacturer and User Facility Device Experience database from January 2000 to June 2011. Outcomes of interest were incidence of inferior vena cava perforation, type of filter, clinical presentation, and management of the perforation, including retrievability rates.
Three hundred ninety-one (12%) cases of inferior vena cava perforation were reported. The annual distribution of inferior vena cava perforation was 35 cases (9%), varying from seven (2%) to 70 (18%). A three-fold increment in the number of adverse events related to inferior vena cava filters has been noted since 2004. Wall perforation as an incidental finding was the most common presentation (N = 268, 69%). Surrounding organ involvement was found in 117 cases (30%), with the aorta being the most common in 43 cases (37%), followed by small bowel in 36 (31%). Filters were retrieved in 97 patients (83%) regardless of wall perforation. Twenty-five (26%) cases required an open procedure to remove the filter. Neither major bleeding requiring further intervention nor mortality was reported.
Inferior vena cava perforation by filters remains stable over the studied years despite increasing numbers of adverse events reported. The majority of filters involved in a perforation were retrievable. Filter retrieval, regardless of inferior vena cava wall perforation, is feasible and must be attempted whenever possible in order to avoid complications.
滤器支柱穿破下腔静脉是一种已知的并发症。我们此次综述的目的是基于一个开放的、自愿参与的国家数据库，评估滤器导致下腔静脉穿破的影响。
我们回顾了2000年1月至2011年6月制造商和用户设施设备经验数据库中报告的3311例下腔静脉滤器不良事件。感兴趣的结果包括下腔静脉穿破的发生率、滤器类型、临床表现以及穿破的处理，包括可取出率。
报告了391例（12%）下腔静脉穿破病例。下腔静脉穿破的年度分布为35例（9%），范围从7例（2%）到70例（18%）。自2004年以来，与下腔静脉滤器相关的不良事件数量增加了两倍。作为偶然发现的壁穿破是最常见的表现（N = 268，69%）。117例（30%）发现有周围器官受累，其中主动脉受累最常见，为43例（37%），其次是小肠，为36例（31%）。无论是否有壁穿破，97例患者（83%）的滤器被取出。25例（26%）病例需要通过开放手术取出滤器。未报告需要进一步干预的大出血情况，也未报告死亡病例。
尽管报告的不良事件数量增加，但在研究期间，滤器导致的下腔静脉穿破情况保持稳定。大多数涉及穿破的滤器是可取出的。无论下腔静脉壁是否穿破，取出滤器都是可行的，并且只要有可能就必须尝试，以避免并发症。
