Tullius Thomas G, Bos Aaron S, Patel Mikin V, Funaki Brian, Van Ha Thuong G
Department of Radiology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2026, Chicago, IL, 60637, USA.
Cardiovasc Intervent Radiol. 2018 Feb;41(2):239-244. doi: 10.1007/s00270-017-1805-z. Epub 2017 Oct 16.
Although recommended placement of IVC filters is with their tips positioned at the level of the renal vein inflow, in practice, adherence is limited due to clinical situation or IVC anatomy. We seek to evaluate the indwelling and retrieval complications of IVC filters based on their specific position within the infrarenal IVC.
Retrospective, single institution study of 333 consecutive infrarenal vena cava filters placed by interventional radiologists in patients with an average age of 62.2 ± 15.7 years was performed between 2013 and 2015. Primary indication was venous thromboembolic disease (n = 320, 96.1%). Filters were classified based on location of the apex below the lowest renal vein inflow on the procedural venogram: less than 1 cm (n = 180, 54.1%), 1-2 cm (n = 96, 28.8%), and greater than 2 cm (n = 57, 17.1%). Denali (n = 171, 51.4%) and Celect (n = 162, 48.6%) filters were evaluated. CT follow-up, indwelling complications, and retrieval data were obtained.
Follow-up CT imaging performed for symptomatic indications occurred for 38.3% of filters placed < 1 cm below the lowest renal vein, 27.1% of filters placed 1-2 cm, and 36.8% placed > 2 cm (p = .16). There was no difference in caval strut penetration, penetration of adjacent viscera, time to penetration, filter migration, or tilt (p = .15, .27, .41, .57, .93). No filter fractures occurred. There was no difference in the incidence of breakthrough PE or complex filter retrieval (p = .83, .59). Only one retrieval failure occurred.
This study suggests filter apex location within the infrarenal IVC, including placement > 2 cm below the level of the renal vein inflow, is not associated with differences in indwelling or retrieval complications.
Level 3 non-randomized controlled follow-up study.
尽管推荐的下腔静脉滤器放置位置是使其尖端位于肾静脉流入水平，但在实际操作中，由于临床情况或下腔静脉解剖结构，依从性有限。我们试图根据下腔静脉滤器在肾下腔静脉内的特定位置评估其留置和取出并发症。
对2013年至2015年间由介入放射科医生为平均年龄62.2±15.7岁的患者连续放置的333个肾下腔静脉滤器进行回顾性单机构研究。主要适应证为静脉血栓栓塞性疾病（n = 320，96.1%）。根据术中静脉造影时滤器尖端低于最低肾静脉流入水平的位置对滤器进行分类：小于1 cm（n = 180，54.1%）、1 - 2 cm（n = 96，28.8%）和大于2 cm（n = 57，17.1%）。对Denali（n = 171，51.4%）和Celect（n = 162，48.6%）滤器进行评估。获取CT随访、留置并发症和取出数据。
对有症状指征进行的CT随访成像显示，放置在低于最低肾静脉1 cm以下的滤器中有38.3%进行了随访，放置在1 - 2 cm的滤器中有27.1%进行了随访，放置在大于2 cm的滤器中有36.8%进行了随访（p = 0.16）。在腔静脉支柱穿透、邻近脏器穿透、穿透时间、滤器迁移或倾斜方面无差异（p = 0.15、0.27、0.41、0.57、0.93）。未发生滤器断裂。在突破性肺栓塞或复杂滤器取出的发生率方面无差异（p = 0.83、0.59）。仅发生1例取出失败。
本研究表明，肾下腔静脉内滤器尖端位置，包括放置在肾静脉流入水平以下大于2 cm处，与留置或取出并发症的差异无关。
3级非随机对照随访研究。
