Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wis.
Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wis.
J Vasc Surg Venous Lymphat Disord. 2022 Jul;10(4):879-886. doi: 10.1016/j.jvsv.2022.01.007. Epub 2022 Feb 3.
Despite the widespread use of inferior vena cava filters (IVCFs), no large controlled trials have examined the IVCF retrieval rates and clinical events for patients without retrieved IVCFs. We hypothesized that IVCF retrieval success would decrease as the time from placement increased and that the clinical event rates would be more prevalent for those without a retrieved IVCF. We evaluated retrieval success as a function of time and compared the rates of venous thromboembolism and mortality between patients who had undergone IVCF retrieval within 12 months vs patients with unsuccessful IVCF retrieval.
All patients who had undergone IVCF placement between 2011 and 2017 with available follow-up data at eight community hospitals were enrolled in our retrospective cohort study. The procedure dates, incidence of subsequent deep vein thrombosis (DVT) and pulmonary embolism, and mortality dates were collected. Patients were classified as having a nonretrieved IVCF if their IVCF had not been retrieved after ≥12 months of follow-up.
Of 1709 patients who had undergone IVCF placement, IVCF retrieval was successful for 770. We found a significant (P = .018) decrease in retrieval success as the time from IVCF insertion increased. After a mean of 36 ± 16 months, the incidence of subsequent DVT was lower in the retrieved group than in the nonretrieved group (8.1% vs 11.9%; P = .05; hazard ratio, 0.65; 95% confidence interval, 0.42-1.00). Mortality was lower for those with retrieved than for those without retrieved IVCFs (8.8% vs 28.8%; P < .001; hazard ratio, 0.5; 95% confidence interval, 0.35-0.7). No significant difference was found in the rate of pulmonary embolism.
IVCF nonretrieval was more likely for older patients with a greater prevalence of comorbid conditions. Increased rates of subsequent DVT and mortality were observed for patients without IVCF retrieval. Finally, the likelihood of successful IVCF retrieval decreased with increased time from IVCF placement.
尽管下腔静脉滤器（IVCF）的应用广泛，但没有大型对照试验检查过未取出 IVCF 的患者的 IVCF 取出率和临床事件。我们假设，随着放置时间的延长，IVCF 取出成功率会降低，且未取出 IVCF 的患者的临床事件发生率更高。我们评估了时间对取出成功率的影响，并比较了在 12 个月内接受 IVCF 取出的患者与 IVCF 未取出的患者之间静脉血栓栓塞和死亡率的发生率。
我们对 2011 年至 2017 年间在 8 家社区医院接受 IVCF 置入且具有随访数据的所有患者进行了回顾性队列研究。收集了手术日期、随后发生的深静脉血栓（DVT）和肺栓塞的发生率以及死亡率。如果患者在随访 12 个月后仍未取出 IVCF，则将其分类为未取出 IVCF。
在 1709 例接受 IVCF 置入的患者中，有 770 例 IVCF 取出成功。我们发现，随着 IVCF 置入时间的延长，取出成功率显著下降（P =.018）。在平均 36 ± 16 个月后，取出组的后续 DVT 发生率低于未取出组（8.1%比 11.9%；P =.05；风险比，0.65；95%置信区间，0.42-1.00）。取出组的死亡率低于未取出组（8.8%比 28.8%；P <.001；风险比，0.5；95%置信区间，0.35-0.7）。两组的肺栓塞发生率无显著差异。
IVCF 未取出更可能见于年龄较大且合并症更多的患者。未取出 IVCF 的患者随后发生 DVT 和死亡的风险更高。最后，IVCF 取出的成功率随放置时间的延长而降低。
