Kesselman Andrew J, Hoang Nam Sao, Sheu Alexander Y, Kuo William T
Division of Vascular and Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3651, Stanford, CA 94305-5642.
Division of Vascular and Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3651, Stanford, CA 94305-5642.
J Vasc Interv Radiol. 2018 Jun;29(6):758-764. doi: 10.1016/j.jvir.2018.01.786. Epub 2018 Apr 26.
To evaluate the safety and efficacy of attempted percutaneous filter fragment removal during retrieval of fractured inferior vena cava (IVC) filters and to report outcomes associated with retained filter fragments.
Over a 5-year period, 82 consecutive patients presenting with a fractured IVC filter were prospectively enrolled into an institutional review board-approved registry. There were 27 men and 55 women (mean, 47 y; range, 19-85 y). After main filter removal, percutaneous removal of fragments was attempted if they were deemed intravascular and accessible on preprocedural computed tomography (CT), cone-beam CT, and/or intravascular ultrasound; distal pulmonary artery (PA) fragments were left alone. A total of 185 fragments were identified (81 IVC, 33 PA, 16 cardiac, 2 hepatic vein, 1 renal vein, 1 aorta, 51 retroperitoneal). Mean filter dwell time was 2,183 days (range, 59-9,936 d). Eighty-seven of 185 fragments (47%) were deemed amenable to attempted removal: 65 IVC, 11 PA, 8 cardiac, 2 hepatic, and 1 aortic. Primary safety outcomes were major procedure-related complications.
Fragment removal was successful in 78 of 87 cases (89.7%; 95% confidence interval [CI], 81.3-95.2). There were 6 minor complications with no consequence (6.9%; 95% CI, 2.6-14.4) involving intraprocedural fragment embolization and 1 major complication (1.1%; 95% CI, 0.0-6.2), a cardiac tamponade that was successfully treated. The complication rate from attempted cardiac fragment removal was 12.5% (1 of 8; 95% CI, 0.3-52.7). Among patients with retained cardiopulmonary fragments (n = 19), 81% remained asymptomatic during long-term clinical follow-up of 845 days (range, 386-2,071 d).
Percutaneous removal of filter fragments from the IVC and proximal PAs is safe and effective overall, but attempted intracardiac fragment removal carries a higher risk of complication. Most residual filter fragments not amenable to percutaneous removal remain asymptomatic and may be monitored clinically.
评估在取出断裂的下腔静脉（IVC）滤器过程中尝试经皮取出滤器碎片的安全性和有效性，并报告与残留滤器碎片相关的结果。
在5年期间，连续82例出现IVC滤器断裂的患者被前瞻性纳入一个经机构审查委员会批准的登记系统。其中男性27例，女性55例（平均年龄47岁；范围19 - 85岁）。在取出主滤器后，如果术前计算机断层扫描（CT）、锥形束CT和/或血管内超声显示碎片位于血管内且可触及，则尝试经皮取出碎片；远端肺动脉（PA）的碎片则不予处理。共识别出185个碎片（81个位于IVC，33个位于PA，16个位于心脏，2个位于肝静脉，1个位于肾静脉）。平均滤器留置时间为2183天（范围59 - 9936天）。185个碎片中有87个（47%）被认为适合尝试取出：65个位于IVC，11个位于PA，8个位于心脏，2个位于肝脏，1个位于主动脉。主要安全结局是与手术相关的主要并发症。
87例中有78例成功取出碎片（89.7%；95%置信区间[CI]，81.3 - 95.2）。有6例轻微并发症（6.9%；95%CI，2.6 - 14.4），未造成后果，包括术中碎片栓塞，1例主要并发症（1.1%；95%CI，0.0 - 6.2），即心脏压塞，经成功治疗。尝试取出心脏碎片的并发症发生率为12.5%（8例中的1例；95%CI，0.3 - 52.7）。在残留心肺碎片的患者（n = 19）中，81%在845天（范围386 - 207天）的长期临床随访中无症状。
总体而言，经皮从IVC和近端PA取出滤器碎片是安全有效的，但尝试取出心脏内碎片的并发症风险较高。大多数不适合经皮取出的残留滤器碎片仍无症状，可进行临床监测。
