Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Intensive Care Med. 2020 Mar;35(3):225-232. doi: 10.1177/0885066619874692. Epub 2019 Sep 5.
Venous thromboembolic disease is a major problem among critically ill patients, with significant associated morbidity and mortality. Many critically ill patients have contraindications to systemic anticoagulation, and inferior vena cava (IVC) filters are an important alternative in preventing pulmonary emboli (PE) in this population. The Angel Catheter (Mermaid, Stenlose, Denmark) is a novel percutaneous and removable IVC filter attached to the end of a triple lumen central venous catheter which has been demonstrated to reduce PE in surgical and trauma patients. This case series describes 18 critically ill medical patients who had an Angel catheter placed either for diagnosed PE or due to high risk for PE; over half had at least submassive PE at the time of Angel catheter placement. None of the patients had a recurrence of PE during Angel catheter use, 29.4% had clot found in the filter via cavogram upon removal, and only one had a minor complication which had no clinical consequence. In 2 patients, the placement of the Angel Catheter resulted in the prevention of PE during catheter-directed thrombolysis of extensive deep vein thrombosis. This case series demonstrates that in a population of critically ill, elderly, and obese medical patients the bedside placement of the Angel IVC filter is feasible, safe, and may be effective for preventing PE.
静脉血栓栓塞性疾病是危重病患者的一个主要问题，与显著相关的发病率和死亡率。许多危重病患者有全身抗凝的禁忌症，下腔静脉（IVC）过滤器是预防该人群肺栓塞（PE）的重要替代方法。Angel 导管（美人鱼， Stenlose，丹麦）是一种新型经皮可移除的 IVC 过滤器，连接在三腔中心静脉导管的末端，已被证明可减少手术和创伤患者的 PE。本病例系列描述了 18 例患有 Angel 导管的危重病医学患者，这些患者要么是确诊的 PE，要么是有发生 PE 的高风险；一半以上的患者在放置 Angel 导管时至少有亚大面积的 PE。在 Angel 导管使用期间，没有患者发生 PE 复发，29.4%的患者在取出时通过腔静脉造影发现过滤器中有血栓，只有 1 例患者出现轻微并发症，但无临床后果。在 2 例患者中，Angel 导管的放置在导管直接溶栓治疗广泛深静脉血栓形成时预防了 PE。本病例系列表明，在一组危重病、老年和肥胖的医学患者中，床边放置 Angel IVC 过滤器是可行的、安全的，并且可能对预防 PE 有效。
