Dorfman G S
Department of Diagnostic Imaging, Rhode Island Hospital, Brown University Program in Medicine, Providence 02902.
Radiology. 1990 Mar;174(3 Pt 2):987-92. doi: 10.1148/radiology.174.3.174-3-987.
Percutaneous placement of caval filters is performed with increasing frequency as an alternative or adjunctive therapy for venous thromboembolic disease. The stainless steel Greenfield filter may be placed surgically or percutaneously. There are now several other approved or investigational devices primarily intended for percutaneous delivery. Morbidity and mortality rates for percutaneous filter placement are lower than those published for surgical filter placement. Choosing among the various devices on the basis of published studies is difficult, as the indications for filter placement; objectivity of follow-up; and criteria for complications, success, and failure vary greatly among studies. The author analyzes published and unpublished data about the physical characteristics; clinical availability; and morbidity, mortality, and efficacy rates of several caval filters. The author concludes that filters should be placed percutaneously rather than surgically, that the ideal device cannot be determined on the basis of current data (and might not exist), and that the choice among devices might depend on clinical circumstances and device characteristics. A strong recommendation is made for an independent, multicenter, prospective, randomized trial and, in the interim, a mandatory registry of all patients receiving caval filters.
作为静脉血栓栓塞性疾病的替代或辅助治疗方法，经皮置入腔静脉滤器的频率越来越高。不锈钢格林菲尔德滤器可通过手术或经皮方式置入。现在还有其他几种主要用于经皮输送的已批准或正在研究的装置。经皮置入滤器的发病率和死亡率低于已公布的手术置入滤器的发病率和死亡率。由于滤器置入的指征、随访的客观性以及并发症、成功和失败的标准在不同研究中差异很大，因此根据已发表的研究在各种装置中进行选择很困难。作者分析了关于几种腔静脉滤器的物理特性、临床可用性以及发病率、死亡率和有效率的已发表和未发表数据。作者得出结论，滤器应通过经皮而非手术方式置入，理想的装置无法根据目前的数据确定（可能也不存在），装置之间的选择可能取决于临床情况和装置特性。强烈建议进行一项独立的、多中心的、前瞻性的随机试验，在此期间，对所有接受腔静脉滤器的患者进行强制性登记。
