University of Alabama School of Medicine, Birmingham, AL.
Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL.
Curr Probl Diagn Radiol. 2021 Sep-Oct;50(5):662-664. doi: 10.1067/j.cpradiol.2020.09.009. Epub 2020 Sep 24.
The technical success and safety of percutaneous inferior vena cava filters (IVCF) retrieval when filter elements are penetrating into adjacent bony structures is unknown. Therefore, our purpose was to evaluate the technical success and safety of IVCF retrieval when filter elements are penetrating into adjacent bone.
Using percutaneous IVCF retrievals from 2008 to 2018 in adult patients, we conducted a multi-institutional, retrospective review of filters found to penetrate lumbar vertebrae by computed tomography scans. Technical success following the retrieval procedure was recorded. Patient records were assessed for complications from retrieval.
13 patients (2 males; 11 females; mean age: 53.2 years (range: 22-71) were included. Hundred percent of the filters were optional (retrievable) filters. Venous thromboembolism (VTE) with a contraindication to anticoagulation (n = 7; 53.8%) and prophylaxis without venous thromboembolism (n = 3; 23.1%) were the 2 most common indications for IVCF placement. Two filters (15.4%) had >15° of tilt relative to the IVC prior to retrieval while no IVCFs had migrated or caused caval thrombosis. One filter (7.7%) was found to have a fractured strut prior to retrieval. Ten patients (76.9%) were either on anticoagulants or antiplatelet medications at the time of retrieval. No patients were on antibiotics and no patients received periprocedural antibiotics. Median dwell time was 116.5 days (range: 49-5395). All 13 IVCFs were successfully retrieved in a single session (technical success: 100%). Standard snare technique was used in 8 cases (61.5%), endobronchial forces were used in 3 cases (23.1%), and wire loop snare technique was used in 2 cases (15.4%). There were no complications in any patient. Percutaneous retrieval of IVCFs with elements that have penetrated into adjacent vertebrae is both safe and technically feasible.
当滤器元件穿透相邻骨结构时，经皮下腔静脉滤器（IVCF）取回的技术成功率和安全性尚不清楚。因此，我们的目的是评估当滤器元件穿透相邻骨时 IVCF 取回的技术成功率和安全性。
我们对 2008 年至 2018 年期间在成年患者中进行的经皮 IVCF 取回进行了一项多机构、回顾性研究，这些患者的计算机断层扫描（CT）扫描显示滤器穿透腰椎。记录取回程序后的技术成功率。评估患者的取回并发症记录。
共纳入 13 例患者（2 例男性；11 例女性；平均年龄 53.2 岁（范围：22-71）。100%的滤器均为可选（可取回）滤器。静脉血栓栓塞症（VTE）伴抗凝禁忌（n=7；53.8%）和无 VTE 预防（n=3；23.1%）是放置 IVCF 的两个最常见指征。在取回之前，有 2 个滤器（15.4%）相对于 IVC 倾斜超过 15°，且没有滤器迁移或引起腔静脉血栓形成。在取回之前，发现 1 个滤器（7.7%）有一个断裂的支柱。10 例（76.9%）患者在取回时正在服用抗凝药或抗血小板药物。没有患者使用抗生素，也没有患者接受围手术期抗生素治疗。中位留置时间为 116.5 天（范围：49-5395）。13 例 IVCF 均在单次治疗中成功取回（技术成功率：100%）。8 例（61.5%）采用标准圈套技术，3 例（23.1%）采用支气管内力，2 例（15.4%）采用线环圈套技术。无任何患者出现并发症。对于穿透相邻椎骨的 IVCF 元素，经皮取回既安全又可行。
