Al-Hakim Ramsey, Kee Stephen T, Olinger Kristen, Lee Edward W, Moriarty John M, McWilliams Justin P
Department of Radiology, Division of Interventional Radiology, University of California, Los Angeles, 757 Westwood Plaza, Suite 2125C, Los Angeles, CA 90095.
Department of Radiology, Division of Interventional Radiology, University of California, Los Angeles, 757 Westwood Plaza, Suite 2125C, Los Angeles, CA 90095.
J Vasc Interv Radiol. 2014 Jun;25(6):933-9; quiz 940. doi: 10.1016/j.jvir.2014.01.019. Epub 2014 Mar 13.
To investigate the success and safety of routine versus advanced inferior vena cava (IVC) filter retrieval techniques.
A retrospective review was performed of patients who underwent IVC filter placement and/or a retrieval attempt over a 10-year period. Retrieval technique(s), preretrieval computed tomography, preretrieval venography, and clinical/imaging follow-up for 30 days after retrieval were analyzed. Mean filter dwell time was 134 days (range, 0-2,475 d).
Filter retrieval was attempted 231 times in 217 patients (39% female, 61% male; mean age, 50.7 y), with success rates of 73.2% (169 of 231) and 94.7% (54 of 57) for routine and advanced filter retrieval techniques, respectively. The overall filter retrieval complication rate was 1.7% (four of 231); complications in four patients (with multiple complications in some cases) included IVC dissection, IVC intussusception, IVC thrombus/stenosis, filter fracture with embedded strut, IVC injury with hemorrhage, and vascular injury from complicated venous access. The rate of complications associated with filter retrievals that required advanced technique was significantly higher than seen with routine technique (5.3% vs 0.4%; P < .05). Longer dwell time, more transverse tilt, and presence of an embedded hook were associated with significantly increased rates of failed retrieval via routine technique (P < .05).
IVC filters can be retrieved with a high overall success rate (98.2%) and a low complication rate (1.7%) by using advanced techniques when the routine approach has failed; however, the use of advanced techniques is associated with a significantly higher complication rate.
探讨常规与先进的下腔静脉（IVC）滤器取出技术的成功率及安全性。
对在10年期间接受IVC滤器置入和/或取出尝试的患者进行回顾性研究。分析取出技术、取出前计算机断层扫描、取出前静脉造影以及取出后30天的临床/影像学随访情况。滤器平均留置时间为134天（范围0 - 2475天）。
对217例患者（39%为女性，61%为男性；平均年龄50.7岁）进行了231次滤器取出尝试，常规和先进滤器取出技术的成功率分别为73.2%（231例中的169例）和94.7%（57例中的54例）。滤器取出的总体并发症发生率为1.7%（231例中的4例）；4例患者出现并发症（部分病例有多种并发症），包括IVC夹层、IVC套叠、IVC血栓/狭窄、滤器骨折伴支柱嵌入、IVC损伤伴出血以及复杂静脉通路导致的血管损伤。需要先进技术的滤器取出相关并发症发生率显著高于常规技术（5.3%对0.4%；P < 0.05）。留置时间较长、横向倾斜度较大以及存在嵌入钩与常规技术取出失败率显著增加相关（P < 0.05）。
当常规方法失败时，采用先进技术取出IVC滤器可获得较高的总体成功率（98.2%）和较低的并发症发生率（1.7%）；然而，使用先进技术与显著更高的并发症发生率相关。
