Wang Haidong, Liu Zhenhua, Zhu Xiaofei, Liu Jianlong, Man Libo
Department of Urology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China.
Department of Vascular Surgery, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, China.
Vasc Endovascular Surg. 2021 Oct;55(7):706-711. doi: 10.1177/15385744211022517. Epub 2021 Jun 3.
Inferior vena cava (IVC) filters are commonly used in China to prevent pulmonary embolisms in patients with deep vein thrombosis. However, IVC filter removal is complicated when the filter has penetrated the IVC wall and endovascular techniques usually fail. The purpose of this study was to evaluate the effectiveness and safety of retroperitoneal laparoscopic-assisted retrieval of wall-penetrating IVC filters after endovascular techniques have failed.
We retrospectively evaluated a series of 8 patients who underwent retroperitoneal laparoscopic-assisted retrieval of a wall-penetrating IVC filter between December 2017 and November 2019. All patients had experienced at least 1 failure with endovascular retrieval before the study. The filters were slanted and the proximal retrieval hooks penetrated the posterior lateral IVC wall in all patients on computed tomography. Demographic information, operation parameters, and complications were recorded and analyzed. All patients were followed up for at least 12 months.
The procedure was successful in all patients. The median surgery time was 53.6 ± 12.7 min and the average blood loss was 45.0 ± 13.5 ml. No serious complication occurred during the patients' hospitalization, which was an average of 6.4 days. The median follow-up time was 15.1 months, and no patient had deep vein thrombosis recurrence.
Retroperitoneal laparoscopic-assisted retrieval is a feasible and effective technique, particularly when proximal retrieval hooks penetrate the posterior lateral wall of the IVC after endovascular techniques have failed. To some extent, the development of this technique at our institution has increased the success rate of filter removal and improved patient satisfaction.
在中国，下腔静脉（IVC）滤器常用于预防深静脉血栓形成患者的肺栓塞。然而，当滤器穿透下腔静脉壁时，IVC滤器取出术会变得复杂，并且血管内技术通常会失败。本研究的目的是评估在血管内技术失败后，腹膜后腹腔镜辅助取出穿透血管壁的IVC滤器的有效性和安全性。
我们回顾性评估了2017年12月至2019年11月期间接受腹膜后腹腔镜辅助取出穿透血管壁的IVC滤器的8例患者。在本研究之前，所有患者至少经历过1次血管内取出失败。计算机断层扫描显示，所有患者的滤器均呈倾斜状，近端取出钩穿透下腔静脉后壁外侧。记录并分析患者的人口统计学信息、手术参数和并发症。所有患者均接受了至少12个月的随访。
所有患者手术均成功。中位手术时间为53.6±12.7分钟，平均失血量为45.0±13.5毫升。患者住院期间平均为6.4天，未发生严重并发症。中位随访时间为15.1个月，无患者深静脉血栓复发。
腹膜后腹腔镜辅助取出术是一种可行且有效的技术，特别是在血管内技术失败后近端取出钩穿透下腔静脉后壁外侧时。在某种程度上，我们机构这项技术的发展提高了滤器取出的成功率并改善了患者满意度。
