Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, USA.
Department of Radiology and Biomedical Imaging, Yale University, New Haven, USA.
Diagn Interv Radiol. 2023 Jul 20;29(4):638-639. doi: 10.4274/dir.2022.221551. Epub 2022 Dec 28.
Most inferior vena cava (IVC) filters are designed for retrieval from a superior approach. Retrieval becomes technically challenging when the central veins in the chest are occluded. In a patient with thrombosis of the bilateral brachiocephalic veins, the authors describe direct puncture of the superior vena cava (SVC) under fluoroscopy, followed by the successful retrieval of a fractured IVC filter using forceps. A snare inserted into the SVC via the common femoral vein was used as a radiopaque target for direct SVC puncture from the lower neck. Cone beam computed tomography and pullback tractography were used to confirm a safe access trajectory. Thus, direct SVC access may be used for filter retrieval in similar clinical scenarios.
大多数下腔静脉（IVC）过滤器的设计是为了从上方取回。当胸部的中心静脉阻塞时，取回就会变得具有挑战性。在一名双侧头臂静脉血栓形成的患者中，作者描述了在透视引导下直接穿刺上腔静脉（SVC），然后使用夹具成功取回断裂的 IVC 过滤器。通过股静脉插入 SVC 的圈套器被用作从下颈部直接 SVC 穿刺的不透射线目标。锥形束计算机断层扫描和拉回轨迹描记术用于确认安全进入轨迹。因此，直接 SVC 进入可能用于类似的临床情况下的过滤器取回。
