Daye Dania, Walker T Gregory
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Curr Treat Options Cardiovasc Med. 2017 Apr;19(4):28. doi: 10.1007/s11936-017-0529-3.
Inferior vena cava (IVC) filter placement is indicated for the treatment of venous thromboembolism (VTE) in patients with a contraindication to or a failure of anticoagulation. With the advent of retrievable IVC filters and their ease of placement, an increasing number of such filters are being inserted for prophylaxis in patients at high risk for VTE. Available data show that only a small number of these filters are retrieved within the recommended period, if at all, prompting the FDA to issue a statement on the need for their timely removal. With prolonged dwell times, advanced techniques may be needed for filter retrieval in up to 60% of the cases. In this article, we review standard and advanced IVC filter retrieval techniques including single-access, dual-access, and dissection techniques. Complicated filter retrievals carry a non-negligible risk for complications such as filter fragmentation and resultant embolization of filter components, venous pseudoaneurysms or stenoses, and breach of the integrity of the caval wall. Careful pre-retrieval assessment of IVC filter position, any significant degree of filter tilting or of hook, and/or strut epithelialization and caval wall penetration by filter components should be considered using dedicated cross-sectional imaging for procedural planning. In complex cases, the risk for retrieval complications should be carefully weighed against the risks of leaving the filter permanently indwelling. The decision to remove an embedded IVC filter using advanced techniques should be individualized to each patient and made with caution, based on the patient's age and existing comorbidities.
对于有抗凝禁忌或抗凝失败的患者，下腔静脉（IVC）滤器置入可用于治疗静脉血栓栓塞症（VTE）。随着可回收IVC滤器的出现及其易于置入的特点，越来越多的此类滤器被插入用于VTE高危患者的预防。现有数据表明，这些滤器中只有少数在推荐期限内被取出，即便取出也是极少的情况，这促使美国食品药品监督管理局（FDA）就及时取出滤器的必要性发表声明。随着留置时间延长，高达60%的病例可能需要采用先进技术来取出滤器。在本文中，我们回顾了标准和先进的IVC滤器取出技术，包括单入路、双入路和解剖技术。复杂的滤器取出会带来不可忽视的并发症风险，如滤器破碎及滤器组件栓塞、静脉假性动脉瘤或狭窄，以及腔壁完整性破坏。在进行手术规划时，应使用专用的横断面成像仔细评估IVC滤器位置、滤器任何明显程度的倾斜或钩状以及/或者支柱上皮化和滤器组件穿透腔壁情况。在复杂病例中，则应仔细权衡取出并发症风险与滤器永久留置风险。对于使用先进技术取出嵌入的IVC滤器的决定，应根据患者年龄和现有合并症，对每个患者进行个体化且谨慎地做出。
