Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Ill.
Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Ill.
J Vasc Surg Venous Lymphat Disord. 2019 Mar;7(2):176-183. doi: 10.1016/j.jvsv.2018.10.014. Epub 2019 Jan 3.
The objective of this study was to demonstrate the safety and efficacy of treatment of inferior vena cava filter (IVCF)-related chronic iliocaval thrombosis with single-session IVCF retrieval and iliocaval recanalization, thereby optimizing stent deployment and avoiding adverse events (AEs) related to stent placement across an obstructed filter.
From January 2015 to April 2018, a cohort of 25 consecutive patients presented for treatment of IVCF-related chronic iliocaval thrombosis with filter retrieval, followed by recanalization with stent placement and adjunctive iliofemoral thrombectomy as needed. Inclusion criteria included computed tomography (CT) imaging and clinical presentations consistent with chronic (>30 days) IVCF-related chronic thrombosis. A retrospective analysis of technical success, clinical success as measured with the Venous Clinical Severity Score, use of advanced filter retrieval techniques, and AEs was performed. Primary patency was evaluated with CT at 1 to 3 months and 1 year. Data analysis was performed using a paired t-test.
There were 25 patients (median age, 58.0 years; standard deviation, 15.6 years) with eight types of IVCF encountered; all were treated in a single session. Technical success was achieved in all patients. Mean improvement in the Venous Clinical Severity Score was 1.4 (95% confidence interval, 1.0-1.7; P < .01) in the venous edema subscore and 0.6 (95% confidence interval, 0.2-1.0; P < .01) in the pain subscore. At 1 to 3 months, iliocaval stent patency was maintained in 96% of patients; unilateral iliac vein stent thrombus was seen in one patient. One-year follow-up was available in eight patients, with CT imaging demonstrating maintained patency. Median filter implantation time was 12.3 months (mean, 41.9 months; range, 0.8-245.1 months; standard deviation, 63.3 months). Advanced IVCF retrieval techniques were required for 17 procedures. One major AE and minor AE occurred; no patients died in the study period.
Single-session iliocaval recanalization with IVCF retrieval has high rates of technical and clinical success in patients with IVCF-related chronic iliocaval thrombosis.
本研究旨在证明单次下腔静脉滤器（IVCF）取出和腔静脉再通治疗下腔静脉滤器相关慢性髂股静脉血栓的安全性和有效性，从而优化支架的部署并避免因支架放置在阻塞的滤器上而产生的不良事件（AE）。
2015 年 1 月至 2018 年 4 月，连续 25 例 IVCF 相关慢性髂股静脉血栓患者接受了 IVCF 取出术，随后根据需要进行再通治疗，包括支架置入和髂股动脉血栓切除术。纳入标准包括 CT 成像和临床表现与慢性（>30 天）IVCF 相关慢性血栓形成一致。对技术成功率、静脉临床严重程度评分（venous clinical severity score，VCSS）评估的临床成功率、高级滤器取出技术的使用和 AE 进行了回顾性分析。采用 CT 在 1-3 个月和 1 年时评估一期通畅率。采用配对 t 检验进行数据分析。
25 例患者（中位年龄 58.0 岁，标准差 15.6 岁）共遇到 8 种类型的 IVCF，均在单次治疗中进行了治疗。所有患者均达到技术成功。静脉水肿亚评分的 VCSS 平均改善 1.4（95%置信区间，1.0-1.7；P<0.01），疼痛亚评分平均改善 0.6（95%置信区间，0.2-1.0；P<0.01）。1-3 个月时，96%的患者髂股静脉支架通畅，1 例患者单侧髂静脉支架血栓形成。8 例患者可进行 1 年随访，CT 成像显示支架通畅。滤器植入中位时间为 12.3 个月（平均 41.9 个月，范围 0.8-245.1 个月，标准差 63.3 个月）。17 例患者需要采用高级 IVCF 取出技术。1 例发生主要 AE 和 1 例发生轻微 AE，研究期间无患者死亡。
在 IVCF 相关慢性髂股静脉血栓患者中，单次髂股静脉再通联合 IVCF 取出术具有较高的技术和临床成功率。
