Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E 68th St, Payson Pavilion 501, New York, NY 10065.
Section of Thrombosis and Benign Hematology, University of Texas MD Anderson Cancer Center, Houston, TX.
AJR Am J Roentgenol. 2021 Mar;216(3):563-569. doi: 10.2214/AJR.20.24817. Epub 2021 Jan 21.
Despite inferior vena cava (IVC) filter practice spanning over 50 years, interventionalists face many controversies in proper utilization and management. This article reviews recent literature and offers opinions on filter practices. IVC filtration is most likely to benefit patients at high risk of iatrogenic pulmonary embolus during endovenous intervention. Filters should be used selectively in patients with acute trauma or who are undergoing bariatric surgery. Retrieval should be attempted for perforating filter and fractured filter fragments when imaging suggests feasibility and favorable risk-to-benefit ratio. Antibiotic prophylaxis should be considered when removing filters with confirmed gastrointestinal penetration. Anticoagulation solely because of filter presence is not recommended except in patients with active malignancy. Anticoagulation while filters remain in place may decrease long-term filter complications in these patients. Patients with a filter and symptomatic IVC occlusion should be offered filter removal and IVC reconstruction. Physicians implanting filters may maximize retrieval by maintaining physician-patient relationships and scheduling follow-up at time of placement. Annual follow-up allows continued evaluation for removal or replacement as appropriate. Advanced retrieval techniques increase retrieval rates but require caution. Certain cases may require referral to experienced centers with additional retrieval resources. The views expressed should help guide clinical practice, future innovation, and research.
尽管下腔静脉 (IVC) 滤器的应用已有 50 多年的历史，但介入医生在其合理使用和管理方面仍面临诸多争议。本文综述了最新文献，并就滤器的应用提出了一些观点。IVC 滤器最有可能使静脉内介入过程中发生医源性肺栓塞风险较高的患者受益。在急性创伤或正在接受减重手术的患者中，应选择性使用滤器。当影像学检查提示可行且风险效益比有利时，应尝试取出穿透性滤器和破裂的滤器碎片。当确认滤器已穿透胃肠道时，应考虑使用抗生素预防。除非患者有活动性恶性肿瘤，否则不建议单纯因滤器存在而抗凝。对于仍有滤器存在的患者，抗凝治疗可能会降低其长期滤器并发症的风险。对于有滤器且存在 IVC 阻塞症状的患者，应考虑取出滤器并进行 IVC 重建。植入滤器的医生可以通过维持医患关系并在植入时安排随访来最大程度地提高取出率。每年进行随访可根据需要继续评估取出或更换。先进的取出技术可提高取出率，但需要谨慎操作。某些情况下可能需要转介至具有更多取出资源的经验丰富的中心。这些观点有助于指导临床实践、未来的创新和研究。
