Jia Zhongzhi, Fuller Tyler A, McKinney J Mark, Paz-Fumagalli Ricardo, Frey Gregory T, Sella David M, Van Ha Thuong, Wang Weiping
Department of Interventional Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, China.
Lake Erie College of Osteopathic Medicine, Bradenton, FL, 34211, USA.
Cardiovasc Intervent Radiol. 2018 May;41(5):675-682. doi: 10.1007/s00270-018-1880-9. Epub 2018 Jan 22.
To investigate the use of retrievable inferior vena cava (IVC) filters in the current practice and analyze the causes of filter left in situ despite initial plans for retrieval.
A systematic search of all English-language studies of retrievable IVC filters was conducted, including clinical trials and observational studies published between January 1984 and March 2016.
A total of 103 studies were identified, including 10 filter models in 20,319 patients. Placement indications were reported for 11,128 (54.8%) patients, including therapeutic (n = 6270; 56.3%) and prophylactic (n = 4858; 43.7%) indications. A total of 13,224 (65.1%) filters were left as permanent devices; 7095 (34.9%) filters were removed. The reasons for filter nonretrieval among the 5308 (40.1%) reported cases were primary permanent indication (21.2%; 1127/5308), death (19.4%; 1031/5308), ongoing pulmonary embolism (PE) protection (19.0%; 1011/5308), failed retrieval (13.7%; 725/5308), loss to follow-up (13.0%; 689/5308), discontinued care (4.4%; 235/5308), physician oversight (4.0%; 213/5308), patient morbidity (2.8%; 149/5308), and patient refusal (2.4%; 128/5308). A total of 7820 patients presented for filter retrieval, and 7095 filters (90.7%) were successfully removed, with a mean indwelling time of 106.6 ± 47.3 days. Breakthrough PE was reported in 2.1% (191/9169) of patients. Filter tilt, recurrent deep vein thrombosis, penetration, IVC thrombosis, migration, and fracture occurred in 7.7% (798/10,348), 7.1% (362/5092), 5.4% (379/7001), 3.9% (345/8788), 1.4% (160/11,679), and 0.5% (50/9509) of patients, respectively.
Approximately two-thirds of retrievable filters were not retrieved even though more than 85% of the filters were initially intended for temporary use. The major reasons for filter left in situ despite initial plans for retrieval were death, need for ongoing PE protection, failed retrieval, loss to follow-up, discontinued care, and physician oversight.
探讨可回收下腔静脉（IVC）滤器在当前临床实践中的使用情况，并分析尽管最初计划取出但滤器仍留置原位的原因。
对所有关于可回收IVC滤器的英文研究进行系统检索，包括1984年1月至2016年3月发表的临床试验和观察性研究。
共识别出103项研究，涉及20319例患者使用的10种滤器型号。报告了11128例（54.8%）患者的置入指征，包括治疗性（n = 6270；56.3%）和预防性（n = 4858；43.7%）指征。共有13224例（65.1%）滤器作为永久性装置留置；7095例（34.9%）滤器被取出。在报告的5308例（40.1%）病例中，滤器未取出的原因包括主要永久性指征（21.2%；1127/5308）、死亡（19.4%；1031/5308）、持续的肺栓塞（PE）保护需求（19.0%；1011/5308）、取出失败（13.7%；725/5308）、失访（13.0%；689/5308）、停止治疗（4.4%；235/5308）、医生疏忽（4.0%；213/5308）、患者发病（2.8%；149/5308）和患者拒绝（2.4%；128/5308）。共有7820例患者前来取出滤器，7095例（90.7%）滤器成功取出，平均留置时间为106.6±47.3天。2.1%（191/9169）的患者发生了突破性PE。滤器倾斜、复发性深静脉血栓形成、穿透、IVC血栓形成、移位和断裂分别发生在7.7%（798/10348）、7.1%（362/5092）、5.4%（379/7001）、3.9%（345/8788）、1.4%（160/11679）和0.5%（50/9509）的患者中。
尽管超过85%的滤器最初打算临时使用，但约三分之二的可回收滤器未被取出。尽管最初计划取出，但滤器仍留置原位的主要原因是死亡、持续的PE保护需求、取出失败、失访、停止治疗和医生疏忽。
