Ryu Robert K, Lewandowski Robert J
Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Semin Thromb Hemost. 2014 Apr;40(3):401-6. doi: 10.1055/s-0034-1370797. Epub 2014 Mar 7.
Many studies have supported the efficacy of inferior vena cava filters (IVCF) in the setting of venous thromboembolic disease, particularly in oncologic patients who are at increased risk. The advent of retrievable IVCF designs has prompted dramatically expanded use for patients with widely accepted indications but also disproportionately so in patients with so-called extended indications. At the same time, an alarming increase in filter-related complications has been reported both in the literature and through regulatory agencies, leading to government agency-issued warnings. The synergistic effect of these two interconnected phenomena is explained through a careful review of the evolution of IVCF device design. Critical differences exist when comparing retrievable IVCF and permanent IVCF. IVCF utilization can be optimized by prospectively identifying which patients are best served by a specific IVCF device. Careful follow-up strategies are also needed to ensure that all IVCFs are removed as soon as they are no longer needed. Finally, adjunctive techniques for removing "difficult" filters help maximize the number of IVCF removed and minimize IVCF left implanted needlessly.
许多研究都证实了下腔静脉滤器（IVCF）在静脉血栓栓塞性疾病中的疗效，尤其是在风险增加的肿瘤患者中。可回收IVCF设计的出现促使其在具有广泛认可适应证的患者中使用大幅增加，但在所谓的扩展适应证患者中使用增加的比例更高。与此同时，文献报道以及监管机构均指出，滤器相关并发症惊人地增加，导致政府机构发布警告。通过仔细回顾IVCF装置设计的演变，可以解释这两种相互关联现象的协同效应。可回收IVCF和永久性IVCF在比较时存在关键差异。通过前瞻性地确定哪些患者最适合使用特定的IVCF装置，可以优化IVCF的使用。还需要仔细的随访策略，以确保所有IVCF在不再需要时尽快取出。最后，用于取出“困难”滤器的辅助技术有助于最大限度地取出IVCF，并尽量减少不必要地留在体内的IVCF数量。
