Walker John A, Milam Matthew, Lopera Jorge E
Department of Radiology, University of Texas Health Science Center at San Antonio, Texas, USA.
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
J Interv Med. 2021 May 12;4(3):139-142. doi: 10.1016/j.jimed.2021.05.001. eCollection 2021 Aug.
PURPOSE: To retrospectively assess the outcomes of Inferior Vena Cava (IVC) filters placed in critically ill patients in the ICU at bedside using digital radiograph (DR) guidance with previous cross-sectional imaging for planning, compared to IVC filters placed by conventional fluoroscopy (CF). METHOD AND MATERIALS: The cohort consisted of 129 IVC filter placements; 48 placed at bedside and 81 placed conventionally from July 2015 to September 2016. Patient demographics, indication, radiation exposures, access site, procedural duration, dwell time, and complications were identified by the EMR. IVC Filter positioning with measurements of tip to renal vein distance and lateral filter tilt were performed when cavograms or post placement CTs were available for review. Statistical analysis was performed using Stata IC 11.2. RESULTS: Technical success of the procedure was 100% in both groups. Procedural duration was longer at the bedside lasting 14.5 +/- 10.2 versus 6.7 +/- 6.0 min (p<0.0001). The bedside DR group had a median radiation exposure of 25 mGy (15-35) and the CF group had mean radiation exposure of 256.94 mGy +/- 158.6. There was no significant difference in distance of IVC tip to renal vein (p=0.31), mispositioning (p=0.59), degree of filter tilt (p=0.33), or rate of complications (p=0.65) between the two groups. CONCLUSION: IVCF placement at the bedside using DR is comparable to CF with no statistical difference in outcomes based on IVCF positioning, degree of lateral tilt or removal issues. It decreased radiation dose, but with overall increased procedural time.
目的:回顾性评估在重症监护病房(ICU)床边使用数字射线摄影(DR)引导并结合之前的横断面成像进行规划放置下腔静脉(IVC)滤器的重症患者的治疗效果,并与通过传统荧光透视(CF)放置IVC滤器的情况进行比较。 方法和材料:该队列包括129例IVC滤器放置病例;2015年7月至2016年9月期间,48例在床边放置,81例采用传统方式放置。通过电子病历识别患者的人口统计学特征、适应证、辐射暴露情况、穿刺部位、手术持续时间、留置时间和并发症。当有腔静脉造影或放置后CT可供复查时,进行IVC滤器定位,并测量滤器尖端到肾静脉的距离以及滤器的侧向倾斜度。使用Stata IC 11.2进行统计分析。 结果:两组手术的技术成功率均为100%。床边手术的持续时间更长,为14.5±10.2分钟,而传统荧光透视组为6.7±6.0分钟(p<0.0001)。床边DR组的辐射暴露中位数为25 mGy(15 - 35),CF组的平均辐射暴露为256.94 mGy±158.6。两组之间IVC滤器尖端到肾静脉的距离(p = 0.31)、位置错误(p = 0.59)、滤器倾斜度(p = 0.33)或并发症发生率(p = 0.65)均无显著差异。 结论:使用DR在床边放置IVC滤器与CF相当,基于IVC滤器定位、侧向倾斜度或取出问题,治疗效果无统计学差异。它降低了辐射剂量,但总体上增加了手术时间。
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