Leong Shelley, Farzanegan Farhad, Moghbel Mateen C, Min Jean, Rajan Sudhir, Liu Chi-Mei, Freed Robert, Loh Shaun, Morshedi Maud, Rana Rich, Wang Danny, Howles-Banerji Gabriel, Bolanos Francis, Wang Stephen L
Department of Critical Care Medicine, UCSF Fresno, Fresno, CA.
Division of Vascular and Interventional Radiology, Kaiser Permanente South Sacramento, Sacramento, CA.
AJR Am J Roentgenol. 2023 Mar;220(3):389-397. doi: 10.2214/AJR.22.28142. Epub 2022 Sep 28.
Specialized inferior vena cava (IVC) filter referral centers can achieve improved retrieval outcomes, potentially facilitating complex retrievals after long filter dwell times. The purpose of this study was to determine the success rate of complex IVC filter retrievals at a large specialized IVC filter referral center and to identify predictors of adverse events during complex retrievals. This retrospective study included patients who underwent complex IVC filter retrieval from March 2014 to June 2018 at a large regional health system with specialized complex retrieval referral centers and interventional radiologists with expertise in such procedures. Complex retrievals methods included a range of loop snare, coaxial sheath, forceps, and snare techniques. Data were collected from the electronic medical record. The success rate of complex retrieval was determined. Factors associated with adverse events during retrieval procedures were explored. The study included 125 patients (51 women, 74 men; mean age, 60 years). The mean filter dwell time at retrieval was 47.5 months (median, 21.8 months). The complex retrieval success rate was 99.2% on the first attempt and 100.0% overall. A total of 11.2% (14/125) of patients experienced an adverse event during retrieval, including 10.4% (13/125) with minor and 0.8% (1/125) with major events. Prolonged dwell time was the only indication for complex retrieval that was significantly associated with adverse events (adverse event rate, 16.7% for patients with this indication vs 5.1% for patients without this indication; = .04). In multiple regression analysis, the only significant independent predictor of adverse events was a filter dwell time of 5 years or longer (odds ratio, 6.98 [95% CI, 1.64-29.81]; = .009). In a specialized referral system with expertise in complex retrieval methods, high retrieval success rates can be achieved in patients who have filters with long dwell times. Nonetheless, longer dwell times are associated with adverse events during retrieval procedures. The observations support performing early filter retrieval and referring patients who have filters with prolonged dwell times to specialized centers.
专业的下腔静脉（IVC）滤器转诊中心能够取得更好的取出效果，可能有助于在滤器留置时间较长后进行复杂的取出操作。本研究的目的是确定一家大型专业IVC滤器转诊中心复杂IVC滤器取出的成功率，并识别复杂取出过程中不良事件的预测因素。这项回顾性研究纳入了2014年3月至2018年6月期间在一个拥有专业复杂取出转诊中心和擅长此类操作的介入放射科医生的大型区域卫生系统中接受复杂IVC滤器取出的患者。复杂取出方法包括一系列圈套器、同轴鞘管、镊子和圈套技术。数据从电子病历中收集。确定了复杂取出的成功率。探讨了取出过程中与不良事件相关的因素。该研究包括125例患者（51名女性，74名男性；平均年龄60岁）。取出时滤器的平均留置时间为47.5个月（中位数为21.8个月）。复杂取出的首次尝试成功率为99.2%，总体成功率为100.0%。共有11.2%（14/125）的患者在取出过程中发生不良事件，其中10.4%（13/125）为轻微事件，0.8%（1/125）为严重事件。留置时间延长是与不良事件显著相关的唯一复杂取出指征（有此指征的患者不良事件发生率为16.7%，无此指征的患者为5.1%；P = 0.04）。在多元回归分析中，不良事件的唯一显著独立预测因素是滤器留置时间为5年或更长（比值比，[95%CI，1.64 - 29.81]；P = 0.009）。在一个具有复杂取出方法专业知识的专业转诊系统中，对于滤器留置时间长的患者可以实现高取出成功率。尽管如此，较长的留置时间与取出过程中的不良事件相关。这些观察结果支持早期进行滤器取出，并将滤器留置时间延长的患者转诊至专业中心。
