Brahmandam Anand, Skrip Laura, Sumpio Bauer, Indes Jeffrey, Dardik Alan, Sarac Timur, Rectenwald John, Chaar Cassius Iyad Ochoa
1 Section of Vascular Surgery, Yale University School of Medicine, New Haven, USA.
2 National Public Health Institute of Liberia, Monrovia, Liberia.
Vascular. 2019 Jun;27(3):291-298. doi: 10.1177/1708538118815394. Epub 2018 Dec 1.
The placement of inferior vena cava filters (IVCF) continues to rise. Vascular specialists adopt different practices based on local expertise. This study was performed to assess the attitudes of vascular specialists towards the placement and retrieval of IVCF.
An online survey of 28 questions related to practice patterns regarding IVCF was administered to 1429 vascular specialists. Vascular specialists were categorized as low volume if they place less than three IVCF per month and high volume if they place at least three IVCF per month. The responses of high volume and low volume were compared using two-sample t-tests and Chi-square tests.
A total of 259 vascular specialists completed the survey (18% response rate). There were 191 vascular surgeons (74%) and 68 interventional radiologists (26%). The majority of responders were in academic practice (67%) and worked in tertiary care centers (73%). The retrievable IVCF of choice was Celect (27%) followed by Denali (20%). Forty-two percent used a temporary IVCF and left it in situ instead of using a permanent IVCF. Eighty-two percent preferred placing the tip of the IVCF at or just below the lowest renal vein. Thirty-one percent obtained a venous duplex of the lower extremities prior to retrieval while 24% did not do any imaging. There were 132 (51%) low volume vascular specialists and 127 (49%) high volume vascular specialists. Compared to low volume vascular specialists, significantly more high volume vascular specialists reported procedural times of less than 30 min for IVCF retrieval (57% vs. 42%, P = 0.026). There was a trend for high volume to have fewer unsuccessful attempts at IVCF retrieval but that did not reach statistical significance ( P = .061). High volume were more likely to have attempted multiple times to retrieve an IVCF (66% vs. 33%, P < .001), and to have used bronchoscopy forceps (32% vs. 14%, P = .001) or a laser sheath (14% vs. 2%, P < .001) for IVCF retrieval. In general, vascular specialists were not comfortable using bronchoscopy forceps (65%) or a laser sheath (82%) for IVCF retrieval.
This study underscores significant variability in vascular specialists practice patterns regarding IVCF. More studies and societal guidelines are needed to define best practices.
下腔静脉滤器（IVCF）的植入数量持续上升。血管专科医生根据当地的专业知识采用不同的操作方法。本研究旨在评估血管专科医生对IVCF植入和取出的态度。
对1429名血管专科医生进行了一项关于IVCF实践模式的28个问题的在线调查。每月植入IVCF少于3个的血管专科医生被归类为低植入量，每月植入至少3个IVCF的医生被归类为高植入量。使用两样本t检验和卡方检验比较高植入量和低植入量医生的回答。
共有259名血管专科医生完成了调查（回复率为18%）。其中有191名血管外科医生（74%）和68名介入放射科医生（26%）。大多数受访者从事学术工作（67%），并在三级医疗中心工作（73%）。首选的可取出IVCF是Celect（27%），其次是Denali（20%）。42%的医生使用临时IVCF并将其留在原位，而不是使用永久性IVCF。82%的医生倾向于将IVCF的尖端放置在最低肾静脉处或其下方。31%的医生在取出前进行了下肢静脉双功超声检查，而24%的医生未进行任何影像学检查。有132名（51%）低植入量血管专科医生和127名（49%）高植入量血管专科医生。与低植入量血管专科医生相比，显著更多的高植入量血管专科医生报告IVCF取出的操作时间少于30分钟（57%对42%，P = 0.026）。高植入量医生在IVCF取出时未成功尝试的次数有减少的趋势，但未达到统计学意义（P = 0.061）。高植入量医生更有可能多次尝试取出IVCF（66%对33%，P < 0.001），并且在IVCF取出时更有可能使用支气管镜钳（32%对14%，P = 0.001）或激光鞘（14%对2%，P < 0.001）。总体而言，血管专科医生对使用支气管镜钳（65%）或激光鞘（82%）进行IVCF取出并不放心。
本研究强调了血管专科医生在IVCF实践模式上存在显著差异。需要更多的研究和社会指南来确定最佳实践方法。
