Section of Interventional Radiology, Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, Calif.
Section of Interventional Radiology, Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, Calif.
J Vasc Surg Venous Lymphat Disord. 2021 May;9(3):691-696. doi: 10.1016/j.jvsv.2020.09.004. Epub 2020 Sep 15.
In the present study, we sought to determine whether early pre-emptive scheduling of inferior vena cava filter (IVCF) removal during the preoperative IVCF placement visit would affect the IVCF removal rate.
All electronically documented IVCF placements at a single institution were reviewed from April 2015 to July 2019. The baseline characteristics included age, the clinical indications for IVCF placement, inpatient/outpatient status, and type of IVCF placed. Statistical analysis was performed using the χ for discrete variables and the two-tailed paired t test for continuous variables.
A total of 599 patients (mean age, 68 years; 273 women and 326 men) had undergone technically successful IVCF placement. During the preoperative consent process for placement, 232 patients had been scheduled for IVCF removal within 3 months after placement. However, 367 patients had not been scheduled for removal at the preoperative consent process. The indications for placement included failure of anticoagulation, a contraindication to anticoagulation (eg, bleeding), preoperative prophylaxis, and others. Of the 232 patients scheduled for IVCF removal during preoperative consent for IVCF placement, 103 (44%) had undergone successful IVCF removal (mean interval from placement, 107 ± 100 days). Of the 367 nonscheduled patients, 89 (24%) had undergone successful IVCF removal (mean time, 184 ± 215 days). We found a significant improvement in the IVCF removal rate between the scheduled and nonscheduled patients (P < .0001). Three patients (all from the scheduled group) had a clot burden within the IVCF, which meant they were inappropriate for removal. These patients were rescheduled and had eventually undergone uncomplicated removal.
Scheduling IVCF removal during the placement encounter significantly increased the IVCF removal rate. This approach could be a viable option for institutions where clinic time and/or resources are limited or unavailable and for patients who have difficulty traveling for clinical evaluations.
本研究旨在探讨在下腔静脉滤器（IVCF）植入术前就诊时提前预约 IVCF 取出是否会影响 IVCF 取出率。
回顾 2015 年 4 月至 2019 年 7 月期间在一家医疗机构进行的所有电子记录的 IVCF 植入术。基线特征包括年龄、IVCF 植入的临床指征、住院/门诊状态和植入的 IVCF 类型。使用 χ²检验进行离散变量分析，使用双尾配对 t 检验进行连续变量分析。
共 599 例患者（平均年龄 68 岁；273 例女性，326 例男性）成功进行了技术上可行的 IVCF 植入术。在术前植入同意过程中，232 例患者被安排在植入后 3 个月内进行 IVCF 取出。然而，367 例患者在术前同意过程中未被安排取出。植入的指征包括抗凝治疗失败、抗凝禁忌（如出血）、术前预防和其他原因。在 232 例被安排在术前植入同意过程中进行 IVCF 取出的患者中，103 例（44%）成功进行了 IVCF 取出（平均间隔时间为 107±100 天）。在 367 例未预约的患者中，89 例（24%）成功进行了 IVCF 取出（平均时间为 184±215 天）。我们发现预约组和未预约组的 IVCF 取出率有显著改善（P<0.0001）。3 例患者（均来自预约组）IVCF 内有血栓负荷，提示不适合取出。这些患者重新安排并最终进行了无并发症的取出。
在植入术就诊时预约 IVCF 取出显著提高了 IVCF 取出率。对于诊所时间和/或资源有限或无法获得的机构以及难以进行临床评估的患者，这种方法可能是一种可行的选择。
