De Gregorio Miguel A, Guirola Jose A, Urbano Jose, Díaz-Lorenzo Ignacio, Muñoz Jose J, Villacastin Elena, Lopez-Medina Antonio, Figueredo Ana L, Guerrero Javier, Sierre Sergio, Blazquez Sanchez Javier, Kuo William T, Jimenez David
Hospital Universitario Lozano Blesa, Universidad de Zaragoza, Zaragoza, Spain.
Hospitales Vithas, Madrid, Spain.
CVIR Endovasc. 2020 May 18;3(1):26. doi: 10.1186/s42155-020-00114-5.
The treatment of venous thromboembolic disease the treatment of choice is systemic anticoagulation. However, the interruption of the inferior vena cava with filters has been recommended when anticoagulation fails or there is a contraindication. Due to the rising inferior vena cava filter (IVCF) complications, physicians are encouraged to retrieve them when there is no longer recommended. In daily practice, it may be a difficult close follow-up of these patients. In this study, the primary objective was to evaluate the IVCF retrieval rate of all implanted filters in a Spanish registry. Secondary objectives were to analyze the causes of failed retrieval, procedure-related complications, and outcomes at a 12-month follow-up.
Three hundred fifty-six vena cava filters were implanted in 355 patients. The types of filter were: Gunther Tulip (Cook Medical) 160 (44.9%), Optease (Cordis) 77 (21.6%), Celect (Cook Medical) 49 (13, 7%), Aegisy (Lifetech Scientific) 33 (9.2%), Option ELITE (Argon Medical devices) 16 (4.4%), Denali filter (BD Bard) 11 (3.08%), ALN filter (ALN) 10 (2.8%). Removal was achieved in 274/356 (76,9%). eighty-two (23,1%) IVCF were not retrieved due to the following: 41 (11,5%) patients required ongoing filtration, 24 IVCF (6,7%) patients died before retrieval, and 17 (4,7%) impossibility of retrieval because of a tilted and embedded filter apex. There were no major complications observed.
The global retrieval rate of IVCF was achieved in 76.9%, and the adjusted retrieval rate was of 94.15% with no major complications. IVCF tilting was associated with failure of filter removal in less than 5% of cases. This study demonstrates that the retrieval procedure of IVCF is controlled by the clinician and not by the interventional radiologist.
静脉血栓栓塞性疾病的治疗,首选的治疗方法是全身抗凝治疗。然而,当抗凝治疗失败或存在禁忌证时,推荐使用下腔静脉滤器进行阻断。由于下腔静脉滤器(IVCF)并发症不断增加,当不再有使用指征时,鼓励医生取出滤器。在日常实践中,对这些患者进行密切随访可能存在困难。在本研究中,主要目的是评估西班牙登记处所有植入滤器的IVCF取出率。次要目的是分析取出失败的原因、与操作相关的并发症以及12个月随访时的结果。
355例患者共植入356个腔静脉滤器。滤器类型包括:Gunther Tulip(库克医疗)160个(44.9%)、Optease(科迪斯)77个(21.6%)、Celect(库克医疗)49个(13.7%)、Aegisy(微创医疗)33个(9.2%)、Option ELITE(氩气医疗设备)16个(4.4%)、Denali滤器(BD巴德)11个(3.08%)、ALN滤器(ALN)10个(2.8%)。274/356个(76.9%)成功取出。82个(23.1%)IVCF未取出,原因如下:41个(11.5%)患者需要持续滤过,24个IVCF(6.7%)患者在取出前死亡,17个(4.7%)因滤器尖端倾斜和嵌入而无法取出。未观察到严重并发症。
IVCF的总体取出率为76.9%,调整后的取出率为94.15%,无严重并发症。IVCF倾斜与不到5%的滤器取出失败相关。本研究表明,IVCF的取出操作由临床医生而非介入放射科医生控制。