Choi Sun-Ju, Lee Sang Yub, Ryeom Hun Kyu, Kim Gab Chul, Lim Jae-Kwang, Lee So Mi, Kim Won Hwa
Department of Radiology, Samsung Medical Center, 81, Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea.
Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea.
Clin Imaging. 2018 Nov-Dec;52:337-342. doi: 10.1016/j.clinimag.2018.09.008. Epub 2018 Sep 19.
To analyze relevant metrics involved in Denali Vena Cava Filter placement via different venous access sites.
Patients with Denali filters inserted between March 2017 and February 2018 were retrospectively analyzed. Pre-procedural and pre-retrieval computed tomography (CT) were reviewed. We compared inferior vena cava (IVC) diameter, filter tilt angle, filter tip IVC wall abutment, fluoroscopy time, and retrieval outcomes by venous access site. Filter tip abutment/limb penetration and procedure-related complications were investigated.
Seventy-eight patients had successfully-placed Denali filters. Seventy-one of 78 (91%) patients had both pre-procedural and pre-retrieval CT. The majority (35 [49%]) were placed via the right femoral vein (left femoral vein: 22 [31%]; right internal jugular vein: 14 [20%]). The jugular approach involved a longer fluoroscopy time (mean 117 ± 37 s [s]) than the right and left femoral approaches (mean 64 ± 21 s, mean 67 ± 15 s, respectively [p < 0.05]). Filter tilt and filter tip abutment were not significantly different between the 3 access routes. Filter tip abutment and limb penetration were observed in 8/71 (11%) and 2/71 (3%) patients, respectively. Filter retrieval was attempted in 68 of 78 (87%) cases, and all filters were successfully retrieved. One filter arm fractured during advanced retrieval; no other procedure related complications were recorded.
Both femoral venous approaches can be safely used for placement of the Denali filter. Femoral venous access involved a shorter fluoroscopy time without any differences in filter tilt and filter tip abutment compared to transjugular access.
分析通过不同静脉入路放置Denali腔静脉滤器所涉及的相关指标。
回顾性分析2017年3月至2018年2月期间植入Denali滤器的患者。对术前和取出前的计算机断层扫描（CT）进行评估。我们比较了下腔静脉（IVC）直径、滤器倾斜角度、滤器尖端与IVC壁的贴合情况、透视时间以及不同静脉入路的取出结果。研究滤器尖端贴合/肢体穿透情况及与手术相关的并发症。
78例患者成功植入Denali滤器。78例患者中有71例（91%）术前行CT检查且取出前也行CT检查。大多数（35例[49%]）通过右股静脉置入（左股静脉：22例[31%]；右颈内静脉：14例[20%]）。颈内静脉入路的透视时间（平均117±37秒[s]）比右股静脉和左股静脉入路更长（分别为平均64±21秒、平均67±15秒[p<0.05]）。三种入路之间滤器倾斜度和滤器尖端贴合情况无显著差异。分别在8/71（11%）和2/71（3%）的患者中观察到滤器尖端贴合和肢体穿透。78例中有68例（87%）尝试取出滤器，所有滤器均成功取出。在高级取出过程中有一个滤器臂断裂；未记录其他与手术相关的并发症。
两种股静脉入路均可安全用于放置Denali滤器。与经颈静脉入路相比，股静脉入路的透视时间更短，且滤器倾斜度和滤器尖端贴合情况无差异。
