Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan.
Cardiovascular Center, Kyoto Katsura Hospital, Kyoto, Japan.
Heart Vessels. 2021 Nov;36(11):1756-1764. doi: 10.1007/s00380-021-01856-5. Epub 2021 Apr 15.
Inferior vena cava filters (IVCFs) have been reported to cause chronic complications. Recently, retrievable IVCFs (r-IVCF) have been increasingly used to prevent acute pulmonary thromboembolism (PTE) and allow retrieval upon reduction of PTE risk. However, the outcomes of their use in Japan remain unknown.
This study retrospectively investigated the acute PTE relapse prevention rate, IVCF retrieval attempt rate, retrieval success rate, and long-term prognosis of 197 patients who underwent r-IVCF insertion at our hospital between 2010 and 2018.
Subjects had a mean age of 68 years and a male-to-female ratio of 1:1. After r-IVCF insertion, the acute PTE prevention rate was 99.5%. The r-IVCF retrieval rate was 55% (108 patients), with a success rate of 99% (107 patients). r-IVCF retrieval was not attempted in 89 cases due to advanced cancer or poor prognosis (41%), loss to follow-up (32%), and long-term indwelling IVCF (17%). The retrieval group had an average observation period of 36 months, with their anticoagulation therapy continuation, PTE recurrence, and deep vein thrombosis (DVT) recurrence rates being 64%, 3%, and 4%, respectively. The non-retrieval group had a mean observation period of 21 months, with their anticoagulation continuation, PTE recurrence, and DVT recurrence rates being 78%, 3%, and 15%, respectively. DVT recurrence rates increased significantly in the non-retrieval group (p < 0.01). Moreover, 65% of all DVTs occurred centrally from the femoral veins, among which 9% were contraindicated for anticoagulation therapy.
IVCF placement significantly prevented acute PTE but promoted recurrent DVTs when not retrieved after risk reduction. Hence, to increase recovery rates, IVCFs be promptly removed when no longer necessary.
下腔静脉滤器（IVCF）已被报道可引起慢性并发症。最近，可回收 IVCF（r-IVCF）已越来越多地用于预防急性肺血栓栓塞症（PTE），并在降低 PTE 风险后允许取出。然而，其在日本的使用效果尚不清楚。
本研究回顾性调查了我院 2010 年至 2018 年间接受 r-IVCF 植入术的 197 例患者的急性 PTE 复发预防率、IVCF 取出尝试率、取出成功率和长期预后。
患者平均年龄为 68 岁，男女比例为 1:1。r-IVCF 植入后，急性 PTE 预防率为 99.5%。r-IVCF 取出率为 55%（108 例），成功率为 99%（107 例）。由于晚期癌症或预后不良（41%）、失访（32%）和长期留置 IVCF（17%），89 例未尝试取出 r-IVCF。取出组平均观察期为 36 个月，其抗凝治疗持续时间、PTE 复发率和深静脉血栓形成（DVT）复发率分别为 64%、3%和 4%。未取出组平均观察期为 21 个月，其抗凝治疗持续时间、PTE 复发率和 DVT 复发率分别为 78%、3%和 15%。未取出组 DVT 复发率明显升高（p<0.01）。此外，所有 DVT 中有 65%是从股静脉中心发生的，其中 9%因抗凝治疗禁忌而无法治疗。
IVCF 放置显著预防了急性 PTE，但在降低风险后未取出时促进了复发性 DVT。因此，为了提高恢复率，当不再需要时，应迅速取出 IVCF。
