Schuchardt Philip, Kis Lilla, Goloubev Alexey, Keshishian Edward, Mhaskar Rahul, Hoots Glenn, Davis Cliff, Massis Kamal, Shaikh Jamil
University of South Florida Department of Interventional Radiology, 2 Tampa General Circle, STC 6102, Tampa, FL, 33606-3571, USA.
Morsani College of Medicine Office of Research, 12901 Bruce B. Downs Blvd., MDC061, Tampa, FL, 33612-4799, USA.
CVIR Endovasc. 2022 Aug 6;5(1):39. doi: 10.1186/s42155-022-00316-z.
Inferior vena cava (IVC) filter retrieval is typically accomplished with standard snare technique. When this fails, more advanced techniques are necessary, especially when removal falls outside a 12-month window. Complications during filter retrieval depend heavily on technique, type of filter, and filter position. In this study we examined safety and efficacy of 536 filter retrievals at a tertiary care center and compared complication rates between standard snare and endobronchial forcep retrieval.
We reviewed 536 cases between August 2015 and August 2020, recording retrieval success rates, patient comorbidities, and complication rates at the time of removal.
Total overall retrieval success was 97.9% (525/536), and complications occurred in approximately 6.0% (32/536) of all cases. Success and complications with standard snare technique alone were 99.4% (345/347) and 1.7% (5 Grade I/II, 1 Grade III) and advanced forcep technique 98.8% (171/173) and 14.5% (22 Grade I/II, 2 Grade III, and 1 Grade IV), respectively. There was no significant difference between the technical success rates of the standard snare technique and forceps techniques (p = 0.60) despite a significantly longer dwell time in patients undergoing forceps retrieval (p < 0.001).
To our knowledge, this is the largest cohort of forceps directed IVC filter retrieval present in the literature. Rates of successful endobronchial forceps and standard snare retrievals in this study are similar to previous reports. Although use of endobronchial forceps may be associated with higher complication rates, this is likely due to prolonged dwell times, filter tilt, and attempted removal of non retrievable filters. Overall, forceps-directed retrieval offers a safe, effective means of removal in difficult cases.
Level 3, Large Retrospective Study.
下腔静脉（IVC）滤器取出通常采用标准圈套技术完成。当该技术失败时，需要更先进的技术，尤其是在取出时间超出12个月窗口期时。滤器取出过程中的并发症在很大程度上取决于技术、滤器类型和滤器位置。在本研究中，我们在一家三级医疗中心检查了536例滤器取出的安全性和有效性，并比较了标准圈套技术和支气管内钳取技术的并发症发生率。
我们回顾了2015年8月至2020年8月期间的536例病例，记录取出成功率、患者合并症以及取出时的并发症发生率。
总体取出成功率为97.9%（525/536），所有病例中约6.0%（32/536）发生并发症。仅采用标准圈套技术时的成功率和并发症发生率分别为99.4%（345/347）和1.7%（5例I/II级，1例III级），而采用先进钳取技术时分别为98.8%（171/173）和14.5%（22例I/II级，2例III级，1例IV级）。尽管采用钳取技术的患者停留时间明显更长（p<0.001），但标准圈套技术和钳取技术的技术成功率之间无显著差异（p = 0.60）。
据我们所知，这是文献中报道的最大规模的支气管内钳取IVC滤器取出队列。本研究中支气管内钳取和标准圈套取出的成功率与先前报道相似。虽然使用支气管内钳可能与较高的并发症发生率相关，但这可能是由于停留时间延长、滤器倾斜以及尝试取出不可取出的滤器所致。总体而言，钳取法取出在困难病例中提供了一种安全、有效的取出方法。
3级，大型回顾性研究。
