Makary Mina S, Kapke Jordan, Yildiz Vedat, Pan Xueliang, Dowell Joshua D
Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
J Vasc Interv Radiol. 2018 Feb;29(2):170-175. doi: 10.1016/j.jvir.2017.09.005. Epub 2017 Dec 6.
To compare the outcomes and costs of inferior vena cava (IVC) filter placement and retrieval in the interventional radiology (IR) and surgical departments at a tertiary-care center.
Retrospective review was performed of 142 sequential outpatient IVC filter placements and 244 retrievals performed in the IR suite and operating room (OR) from 2013 to 2016. Patient demographic data, procedural characteristics, outcomes, and direct costs were compared between cohorts.
Technical success rates of 100% were achieved for both IR and OR filter placements, and 98% of filters were successfully retrieved by IR means, compared with 83% in the OR (P < .01). Fluoroscopy time was similar for IR and OR filter insertions, but IR retrievals required half the fluoroscopy time, with an average of 9 minutes vs 18 minutes in the OR (P = .02). There was no significant difference between cohorts in the incidences of complications for filter retrievals, but more postprocedural complications were observed for OR placements (8%) vs IR placements (1%; P = .05). The most severe complication occurred during an OR filter retrieval, resulting in entanglement of the snare device and conversion to an emergent open filter removal by vascular surgery. Direct costs were approximately 20% higher for OR vs IR IVC filter placements ($2,246 vs $2,671; P = .01).
Filter placements are equally successfully performed in IR and OR settings, but OR patients experienced significantly higher postprocedural complication rates and incurred higher costs. In contrast, higher technical success rates and shorter fluoroscopy times were observed for IR filter retrievals compared with those performed in the OR.
比较在一家三级医疗中心的介入放射科（IR）和外科放置及取出下腔静脉（IVC）滤器的结果和成本。
对2013年至2016年在IR室和手术室（OR）进行的142例连续门诊IVC滤器放置和244例取出进行回顾性分析。比较两组患者的人口统计学数据、手术特征、结果和直接成本。
IR和OR放置滤器的技术成功率均达到100%，98%的滤器通过IR方法成功取出，而OR的成功率为83%（P < 0.01）。IR和OR插入滤器的透视时间相似，但IR取出滤器所需的透视时间仅为OR的一半，平均分别为9分钟和18分钟（P = 0.02）。两组滤器取出并发症的发生率无显著差异，但OR放置后观察到的术后并发症更多（8%），而IR放置后为1%（P = 0.05）。最严重的并发症发生在OR取出滤器期间，导致圈套器缠绕，最终由血管外科转为紧急开放式滤器取出。OR放置IVC滤器的直接成本比IR高约20%（2246美元对2671美元；P = 0.01）。
在IR和OR环境中放置滤器同样成功，但OR患者术后并发症发生率显著更高，成本也更高。相比之下，与OR相比，IR取出滤器的技术成功率更高，透视时间更短。
