Chow Felix Che-Lok, Chan Yiu-Che, Cheung Grace Chung-Yan, Cheng Stephen Wing-Keung
Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
Ann Vasc Surg. 2015 Jul;29(5):985-94. doi: 10.1016/j.avsg.2015.01.009. Epub 2015 Mar 7.
Inferior vena cava (IVC) filters are used to prevent pulmonary embolism (PE), especially in patients with active contraindication to systemic anticoagulation. The aim of this study is to examine the outcomes of patients who received permanent IVC filters at our institution.
This is a single-center retrospective observational study with review of a prospectively collected database for patients who had permanent IVC filters. Patient demographics, indications of filter placement, postprocedure clinical outcome and complications, as well as use of anticoagulant therapy were documented. Chi-squared test was used to test for statistically significant differences (IBM SPSS version 21; IBM Corp., Armonk, NY), while survival was calculated using Kaplan-Meier survival curves analysis.
Between February 1998 and December 2013, a total of 109 patients with a median age of 65 (47 men, range 19-97) years had IVC filters inserted at our institution. All of them had documented venous thromboembolism (VTE) before filter placement: 99 (90.8%) had lower extremity deep vein thrombosis (DVT) (including 34 iliac, 65 infrainguinal), 9 (8.3%) had massive PE without evidence of lower limb DVT, and 1 (0.9%) had isolated IVC thrombosis. Forty-seven (43.1%) patients had PE before filter insertion. There were 2 serious procedure-related complications: one access site thrombosis and one right ventricular perforation. With a mean follow-up of 36 ± 33 months, no patient had further symptomatic PE or paradoxical embolism. There were a total of 54 (49.5%) deaths, with a 30-day mortality of 8.3%; none of them was device or procedure related. Among the 92 patients followed up, 27 (29.3%) had further VTE-either DVT in the index or the contralateral lower limb (20 patients, 21.7%), or thrombus inside the filter or the IVC (14 patients, 15.2%). Forty-one (44.6%) patients reported post-thrombotic syndrome (PTS) symptoms. Anticoagulant therapy was given to 39 (42.4%) and 55 (59.8%) patients in the periprocedural period and at any time during the study period, respectively. It did not reduce the rate of postfilter VTE or PTS in both instances. None of the filters in this series was retrieved.
This observational study showed that IVC filters were effective in the prevention of PE, although symptomatic postfilter VTE and PTS were common, leading to significant morbidity. Patients who received permanent filters have high mortality on follow-up; however, none were procedure or device related.
下腔静脉（IVC）滤器用于预防肺栓塞（PE），尤其是在存在全身抗凝治疗绝对禁忌证的患者中。本研究的目的是探讨在我们机构接受永久性IVC滤器植入的患者的治疗结果。
这是一项单中心回顾性观察性研究，回顾了前瞻性收集的永久性IVC滤器植入患者数据库。记录了患者的人口统计学资料、滤器植入指征、术后临床结局和并发症，以及抗凝治疗的使用情况。采用卡方检验来检验统计学上的显著差异（IBM SPSS 21版；IBM公司，纽约州阿蒙克），同时使用Kaplan-Meier生存曲线分析来计算生存率。
在1998年2月至2013年12月期间，共有109例患者在我们机构植入了IVC滤器，中位年龄为65岁（47例男性，年龄范围19 - 97岁）。所有患者在植入滤器前均有静脉血栓栓塞（VTE）记录：99例（90.8%）有下肢深静脉血栓形成（DVT）（包括34例髂静脉、65例腹股沟下静脉），9例（8.3%）有大面积PE且无下肢DVT证据，1例（0.9%）有孤立性IVC血栓形成。47例（43.1%）患者在植入滤器前有PE。有2例严重的与手术相关的并发症：1例穿刺部位血栓形成和1例右心室穿孔。平均随访36 ± 33个月，无患者发生进一步的症状性PE或反常栓塞。共有54例（49.5%）患者死亡，30天死亡率为8.3%；均与器械或手术无关。在92例接受随访的患者中，27例（29.3%）发生了进一步的VTE，即索引下肢或对侧下肢DVT（20例患者，21.7%），或滤器内或IVC内血栓形成（14例患者，15.2%）。41例（44.6%）患者报告有血栓形成后综合征（PTS）症状。在围手术期和研究期间的任何时间，分别有39例（42.4%）和55例（59.8%）患者接受了抗凝治疗。在这两种情况下，抗凝治疗均未降低滤器植入后VTE或PTS的发生率。本系列中无一例滤器被取出。
这项观察性研究表明，IVC滤器在预防PE方面是有效的，尽管滤器植入后有症状的VTE和PTS很常见，导致显著的发病率。接受永久性滤器植入的患者在随访中有较高的死亡率；然而，均与手术或器械无关。
