Tamrazi Anobel, Wadhwa Vibhor, Holly Brian, Bhagat Nikhil, Marx Jonathan K, Streiff Michael, Lessne Mark L
Division of Vascular & Interventional Radiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheik Zayed Towers, Suite 7203, Baltimore, MD, 21287, USA.
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Cardiovasc Intervent Radiol. 2016 Apr;39(4):538-46. doi: 10.1007/s00270-015-1214-0. Epub 2015 Oct 20.
To evaluate the feasibility, risks, and techniques of percutaneous removal of permanent TrapEase and Simon Nitinol IVC filters.
Between August 2011 and August 2015, 12 patients (5 women, 7 men; age range, 26-75 years) underwent an attempt at percutaneous removal of permanent TrapEase (10) and Simon Nitinol (2) IVC filters due to a history of IVC filter complications or need for lifelong anticoagulation due to the filter. Medical records were reviewed for filter dwell time, presence of iliocaval deep venous thrombosis, procedural technique, and complications.
Filter dwell times ranged from 7 days to 15 years (mean 5.1 years). Successful removal of permanent IVC filters was possible in 11 of 12 patients (91.6%). In 1 patient, a chronically thrombosed IVC filter could not be removed despite laser sheath assistance, but was successfully recanalized with the PowerWire RF guidewire. In the failed retrieval attempt, a stent was placed through the chronically thrombosed IVC filter with restoration of in-line flow. One major complication of large venous groin hematoma was encountered.
In carefully selected patients, percutaneous removal of permanent IVC filters can be performed safely despite prolonged filter dwell times. Extraction of chronically embedded permanent IVC filters may be facilitated by jugular and femoral approaches, often with laser sheath assistance. Chronic filter thrombosis and caval scarring may increase the risk of retrieval failure.
评估经皮取出永久性TrapEase和Simon镍钛合金下腔静脉滤器的可行性、风险及技术。
2011年8月至2015年8月期间，12例患者（5例女性，7例男性；年龄范围26 - 75岁）因下腔静脉滤器并发症史或因滤器需要终身抗凝，尝试经皮取出永久性TrapEase（10例）和Simon镍钛合金（2例）下腔静脉滤器。回顾病历以了解滤器留置时间、髂股深静脉血栓形成情况、操作技术及并发症。
滤器留置时间从7天至15年不等（平均5.1年）。12例患者中有11例（91.6%）成功取出永久性下腔静脉滤器。1例患者，尽管有激光鞘辅助，慢性血栓形成的下腔静脉滤器仍无法取出，但通过PowerWire射频导丝成功再通。在取出失败的尝试中，通过慢性血栓形成的下腔静脉滤器置入支架，恢复了直线血流。遇到1例大静脉腹股沟血肿的主要并发症。
在精心挑选的患者中，尽管滤器留置时间延长，经皮取出永久性下腔静脉滤器仍可安全进行。颈静脉和股静脉途径常借助激光鞘辅助，可能有助于取出长期嵌入的永久性下腔静脉滤器。慢性滤器血栓形成和腔静脉瘢痕可能增加取出失败的风险。
