Lambe Bryant D, Bedway Joseph J, Friedell Mark L
University of Central Florida College of Medicine, Orlando, FL.
Ann Vasc Surg. 2013 Nov;27(8):1169-72. doi: 10.1016/j.avsg.2013.02.014. Epub 2013 Aug 26.
The efficacy of inferior vena cava (IVC) filters in the prevention of pulmonary embolism in patients with lower extremity deep venous thrombosis (DVT) has been well described. What remains uncertain is the risk of insertion-site thrombosis of the femoral vein after filter placement. Historically, the risk was relatively high, most likely due to large delivery systems and therefore a need for longer compression at the insertion site to provide hemostasis. The purpose of this prospective study was to determine the incidence of thrombus formation at the femoral vein puncture site after percutaneous insertion of contemporary IVC filters.
From October 2010 to November 2011, 61 consecutive patients underwent placement of an IVC filter by 3 vascular surgeons and 3 interventional radiologists at our tertiary-care Level I trauma center. All filters were inserted through the right or left common femoral vein. Duplex ultrasound studies (DUS) were performed within 24 hours before filter placement and 24‒72 hours after filter placement.
Fifty-six patients completed the study, including 46 men and 10 women. They ranged in age from 19 to 90 (mean 50) years. Forty-one filters (73%) were placed for prophylaxis: 39 of the patients were trauma victims with immobility and/or contraindications to anticoagulation, 1 had an intracranial hemorrhage with an underlying malignancy, and 1 had very limited mobility. The remaining 15 filters (27%) were placed because of an acute DVT with a contraindication to or a complication from anticoagulation. The filters utilized were: Boston Scientific-Greenfield (n=25); Cook-Celect (n=18); Bard-G2X (n=2); Bard-Eclipse (n=6); and Cordis-TrapEase (n=5). Sheath diameters ranged from 6- to 12-French. None of the 56 patients had thrombus formation at the insertion site on follow-up DUS.
Based on our study findings, the risk of femoral insertion-site thrombosis after percutaneous placement of contemporary IVC filters is negligible. Concern for femoral vein thrombosis should not be a reason for using the internal jugular vein to deploy IVC filters.
下腔静脉（IVC）滤器在预防下肢深静脉血栓形成（DVT）患者发生肺栓塞方面的疗效已得到充分描述。滤器置入后股静脉穿刺部位血栓形成的风险仍不确定。从历史上看，该风险相对较高，很可能是由于输送系统较大，因此需要在穿刺部位进行更长时间的压迫以实现止血。这项前瞻性研究的目的是确定经皮置入当代IVC滤器后股静脉穿刺部位血栓形成的发生率。
2010年10月至2011年11月，在我们的一级创伤中心，3名血管外科医生和3名介入放射科医生为61例连续患者置入了IVC滤器。所有滤器均通过右侧或左侧股总静脉置入。在滤器置入前24小时内以及置入后24 - 72小时进行双功超声检查（DUS）。
56例患者完成了研究，其中男性46例，女性10例。年龄范围为19至90岁（平均50岁）。41个滤器（73%）用于预防：39例患者为创伤受害者，存在活动受限和/或抗凝禁忌证，1例患有颅内出血并伴有潜在恶性肿瘤，1例活动能力非常有限。其余滤器15个（27%）因急性DVT且存在抗凝禁忌证或抗凝并发症而置入。所使用的滤器包括：波士顿科学公司的格林菲尔德滤器（n = 25）；库克公司的Celect滤器（n = 18）；巴德公司的G2X滤器（n = 2）；巴德公司的Eclipse滤器（n = 6）；以及科迪斯公司的TrapEase滤器（n = 5）。鞘管直径范围为6至12法式。56例患者在随访DUS检查中均未出现穿刺部位血栓形成。
基于我们的研究结果，经皮置入当代IVC滤器后股静脉穿刺部位血栓形成的风险可忽略不计。对股静脉血栓形成的担忧不应成为使用颈内静脉置入IVC滤器的理由。
