Pan Ye, Zhao Jun, Mei Jiacai, Shao Mingzhe, Zhang Jian, Wu Haisheng
Department of Vascular Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
Department of Vascular Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
Phlebology. 2016 Sep;31(8):564-72. doi: 10.1177/0268355515597632. Epub 2015 Aug 6.
To investigate nonpermanent inferior vena cava (IVC) filter in the prevention of perioperative pulmonary embolism (PE) in patients of lower extremity and/or pelvic bone fracture with deep vein thrombosis (DVT).
Lower extremity or pelvic bone fracture patients with lower extremity DVT hospitalized in our hospital from January 2003 to October 2014 were retrospectively analyzed. Data was analyzed for age, gender, position of fracture, position of proximal of thrombosis, indications of placement, complications, retrieval rate, and rate of entrapped filter clot. Patients who underwent IVC filter placement were selected as the filter group. The patients who did not perform IVC filter placement after 2008 and the cases between January 2003 and December 2007 were selected as control group 1 and control group 2, respectively. The incidence of perioperative symptomatic PE and mortality were analyzed.
A total of 2763 cases complicated with DVT underwent orthopedic surgery between January 2003 and October 2014. 823 nonpermanent filters were inserted. All filters were successfully deployed with no major complications. After a mean 14.2 days indwelling time, all of temporary filters were removed. Retrieval was attempted in 556 patients with retrievable filters and was successful in 545 (98%); mean indwelling time was 16.3 days. The total retrieval rate was 90%. The incidence of PE in the filter group was significantly lower compared with the two control groups. Among the patients who received chemical anticoagulant therapy, the incidence of PE in filter group, control group 1 and control group 2 were 0.14%, 1.60% and 2.10%, respectively. The incidence of PE in filter group was also significant lower compared with control groups.
Nonpermanent IVC filter placement seems like to be a safe and effective method for preventing perioperative symptomatic and fatal PE in bone fracture patients with DVT in the present retrospective study.
探讨临时性下腔静脉（IVC）滤器在预防下肢和/或骨盆骨折合并深静脉血栓形成（DVT）患者围手术期肺栓塞（PE）中的作用。
回顾性分析2003年1月至2014年10月在我院住院的下肢或骨盆骨折合并下肢DVT患者。分析患者的年龄、性别、骨折部位、血栓近端位置、置入指征、并发症、取出率及滤器内血栓形成率。将行IVC滤器置入的患者作为滤器组。将2008年后未行IVC滤器置入的患者及2003年1月至2007年12月间的病例分别作为对照组1和对照组2。分析围手术期有症状PE的发生率及死亡率。
2003年1月至2014年10月间共有2763例合并DVT的患者接受了骨科手术。置入了823个临时性滤器。所有滤器均成功置入，无严重并发症。平均留置14.2天后，所有临时性滤器均被取出。556例可取出滤器的患者尝试取出滤器，545例（98%）成功取出；平均留置时间为16.3天。总取出率为90%。滤器组PE的发生率明显低于两个对照组。在接受化学抗凝治疗的患者中，滤器组、对照组1和对照组2的PE发生率分别为0.14%、1.60%和2.10%。滤器组PE的发生率也明显低于对照组。
在本回顾性研究中，临时性IVC滤器置入似乎是预防骨折合并DVT患者围手术期有症状及致死性PE的一种安全有效的方法。
