Chen Liang, Shi Wanyin, Gu Jianping, He Xu, Lou Wensheng
Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, China.
BMC Cardiovasc Disord. 2018 Apr 11;18(1):64. doi: 10.1186/s12872-018-0799-z.
A permanently indwelling filter in the inferior vena cava (IVC) may induce caval thrombosis, which could develop and evolve from an acute to a chronic phase. The differential diagnosis of acute and chronic thromboses determines the treatment strategy. The role of computed tomography (CT) in diagnosing acute and chronic intra-filter and IVC thromboses has not been well established. This retrospective study summarizes the CT signs that indicate acute and chronic phases of intra-filter and IVC thromboses.
This study included eight patients who developed a lower-extremity deep venous thrombosis (DVT) and were treated with intracaval filter placement as an alternative to anticoagulation and thrombolysis. During the follow-up, all patients developed an intra-filter thrombosis in the IVC confirmed by CT and/or CT venography (CTV). Demographic and CT data of all patients during the follow-up period were collected for analysis.
All patients had normal-appearing IVCs prior to filter placement, as shown on trans-femoral venography. Eight filters (five TrapEase, three OptEase) were placed in the eight IVCs, respectively. Subsequently, IVC-CT or CTV revealed acute intra-filter or IVC thrombosis in all eight patients, manifesting as an intracaval filling defect and thickened IVC wall. Filter protrusion and secondary caval atrophy seen on CT indicated a chronically occluded IVC.
IVC thrombosis may result from filter placement. The chronicity of caval thrombotic occlusion is likely to be associated with filter protrusion and secondary IVC atrophy revealed on CT scans.
下腔静脉（IVC）内的永久性留置滤器可能诱发腔静脉血栓形成，其可从急性期发展演变为慢性期。急性和慢性血栓形成的鉴别诊断决定了治疗策略。计算机断层扫描（CT）在诊断滤器内及下腔静脉急性和慢性血栓形成中的作用尚未完全明确。本回顾性研究总结了提示滤器内及下腔静脉血栓形成急性和慢性期的CT征象。
本研究纳入8例发生下肢深静脉血栓形成（DVT）且接受腔静脉滤器置入术作为抗凝和溶栓替代治疗的患者。随访期间，所有患者经CT和/或CT静脉造影（CTV）证实下腔静脉内出现滤器内血栓形成。收集所有患者随访期间的人口统计学和CT数据进行分析。
经股静脉造影显示，所有患者在滤器置入前下腔静脉外观正常。分别在8名下腔静脉中置入了8个滤器（5个TrapEase滤器，3个OptEase滤器）。随后，IVC-CT或CTV显示所有8例患者均出现滤器内或下腔静脉急性血栓形成，表现为腔内充盈缺损和下腔静脉壁增厚。CT上显示的滤器突出和继发的腔静脉萎缩提示下腔静脉慢性闭塞。
下腔静脉血栓形成可能由滤器置入引起。腔静脉血栓闭塞的慢性化可能与CT扫描显示的滤器突出和继发的下腔静脉萎缩有关。
