Grassi C J, Goldhaber S Z
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Herz. 1989 Jun;14(3):182-91.
The availability of a safe, effective, and easily introducible percutaneous vena cava filter is crucial in the management of certain patients with pulmonary embolism. If thrombolytic or anticoagulant therapy for pulmonary embolism is contraindicated or fails, interruption of the inferior vena cava (IVC) blood flow is the logical alternative. Indications for filter insertion include a contraindication to anticoagulation, or recurrent pulmonary embolism despite adequate anticoagulation therapy. Common routes of filter insertion are from the right internal jugular vein, or the right or left femoral veins. The Mobin-Uddin umbrella filter (no longer available in the USA) and the Kimray-Greenfield filters have been the most widely used. Complications of vena cava filters include malpositioning, migration, venous thrombosis proximal or distal to the filter, hemorrhage at the percutaneous site of insertion, or sepsis. Despite these problems, IVC filters have been extremely useful in the management of pulmonary embolism among certain subsets of patients. Percutaneously inserted filters have now superseded surgical vena caval interruption in most US centers. Newer filters are currently under development in the US and Europe, and feature improved filtering function, anti-tilt abilities, retrievability, memory wire properties, and improved ease of insertion.
对于某些肺栓塞患者的治疗而言，拥有一种安全、有效且易于植入的经皮腔静脉滤器至关重要。如果肺栓塞的溶栓或抗凝治疗存在禁忌或失败，中断下腔静脉（IVC）血流是合理的替代方案。滤器植入的适应证包括抗凝禁忌，或尽管进行了充分的抗凝治疗仍发生复发性肺栓塞。滤器植入的常见途径是经右颈内静脉，或右或左股静脉。莫宾 - 乌丁伞形滤器（在美国已不再可用）和金雷 - 格林菲尔德滤器是使用最广泛的。腔静脉滤器的并发症包括位置不当、移位、滤器近端或远端的静脉血栓形成、经皮插入部位出血或败血症。尽管存在这些问题，但腔静脉滤器在某些患者亚组的肺栓塞治疗中极其有用。在美国的大多数中心，经皮插入的滤器现已取代了手术性腔静脉中断术。美国和欧洲目前正在研发更新型的滤器，其特点是过滤功能改善、抗倾斜能力增强、可回收性提高、记忆金属丝性能改善以及插入更容易。
