Charlton-Ouw Kristofer M, Afaq Shaikh, Leake Samuel S, Sandhu Harleen K, Sola Cristina N, Saqib Naveed U, Azizzadeh Ali, Safi Hazim J
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX; Memorial Hermann Hospital System, Houston, TX.
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX; Memorial Hermann Hospital System, Houston, TX.
Ann Vasc Surg. 2018 Jan;46:205.e5-205.e11. doi: 10.1016/j.avsg.2017.05.038. Epub 2017 Jun 8.
Despite recommendations for retrieval of inferior vena cava (IVC) filters, most are not removed in a timely manner. Longer IVC filter dwell times are associated with caval wall perforation and tilting that make percutaneous retrieval more difficult. Open IVC filter removal is generally reserved for patients with symptoms referable to the filter, such as chronic back and abdominal pain. We present our management algorithm and review of cases of open IVC filter removal.
Patients referred for management of implanted IVC filters from May 2010 to May 2016 were included. Demographic and imaging were reviewed for cases requiring open surgical removal.
There were 221 percutaneous retrieval attempts in 218 patients. Successful retrieval occurred in 196 (89%) attempts. There were 7 patients who had open surgical IVC filter removal after failure of percutaneous retrieval. One patient had 2 filters and another had 3 filters. Except for 1 case with complications during the percutaneous retrieval procedure, the remaining patients all suffered from back or abdominal pain. All had significant filter strut penetration through the caval wall into adjacent structures. Postoperatively, all patients had relief of pain. There were no deaths and 1 patient had a minor ileus that spontaneously resolved.
Patients who fail percutaneous IVC filter retrieval can expect low morbidity and prompt resolution of symptoms after open surgical removal via minilaparotomy.
尽管有关于取出下腔静脉（IVC）滤器的建议，但大多数滤器并未及时取出。IVC滤器留置时间延长与腔静脉壁穿孔和倾斜有关，这使得经皮取出更加困难。开放性IVC滤器取出术通常仅用于有与滤器相关症状的患者，如慢性背痛和腹痛。我们展示了我们的管理算法并回顾了开放性IVC滤器取出术的病例。
纳入2010年5月至2016年5月因植入IVC滤器而转诊进行处理的患者。对需要开放性手术取出的病例进行人口统计学和影像学检查。
218例患者进行了221次经皮取出尝试。196次（89%）尝试成功取出。7例患者在经皮取出失败后接受了开放性手术IVC滤器取出术。1例患者有2个滤器，另1例有3个滤器。除1例在经皮取出过程中出现并发症外，其余患者均有背痛或腹痛。所有患者均有滤器支柱明显穿透腔静脉壁进入相邻结构的情况。术后，所有患者疼痛均缓解。无死亡病例，1例患者出现轻度肠梗阻，自行缓解。
经皮IVC滤器取出失败的患者通过小切口剖腹手术进行开放性手术取出后，发病率较低，症状能迅速缓解。
