Tian Xuan, Liu Jianlong, Li Jinyong, Jia Wei, Jiang Peng, Cheng Zhiyuan, Zhang Yunxin, Liu Xiao, Zhou M I, Tian Chenyang
Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China.
Front Cardiovasc Med. 2023 Apr 17;10:1127886. doi: 10.3389/fcvm.2023.1127886. eCollection 2023.
The permanent placement of inferior vena cava (IVC) filters may lead to numerous complications and their removal is recommended once the risk of pulmonary embolism is reduced. Removal of IVC filters by endovenous means is preferred. But failure of endovenous removal happens when recycling hooks penetrate the vein wall and filters are left in place for too long time. In these scenarios, open surgery may be effective for removal of IVC filters. We aimed to describe the surgical approach, outcomes, and 6-month follow-up of the removal of IVC filter by open surgery, after the failure of removal the endovenous method.
A total of 1,285 patients with retrievable IVC filters were admitted from July 2019 to June 2021, including 1,176 (91.5%) endovenous filter removals, and 24 (1.9%) open surgical IVC filter removals after the failure by endovenous method, of whom 21 (1.6%) were followed-up and eligible for analysis of the study. Patient characteristics, filter type, filter removal rate, IVC patency rate, and complications were retrospectively analyzed.
Twenty-one patients were left with IVC filters for 26 (10, 37) months, of which 17 (81.0%) patients had non-conical filters and 4 (19.0%) had conical filters; all 21 filters were successfully removed, with a 100% removal rate, no deaths, no serious complications, and no symptomatic pulmonary embolism. At the 3rd month follow-up after surgery and 3rd month follow-up after discontinuation of anticoagulation therapy, only 1 case (4.8%) had IVC occlusion, but without any occurrence of new lower limb deep venous thrombosis and silent pulmonary embolism.
Open surgery can be used for the removal of IVC filters after failure of removal by endovenous method or when accompanied by complications without symptoms of pulmonary embolism. Open surgical approach can be used as an adjunctive clinical intervention for the removal of such filters.
下腔静脉（IVC）滤器的长期放置可能导致多种并发症，一旦肺栓塞风险降低，建议取出滤器。经静脉方式取出IVC滤器是首选。但当回收钩穿透静脉壁且滤器留置时间过长时，经静脉取出会失败。在这些情况下，开放手术可能对取出IVC滤器有效。我们旨在描述经静脉取出方法失败后，通过开放手术取出IVC滤器的手术方法、结果及6个月随访情况。
2019年7月至2021年6月共收治1285例可回收IVC滤器患者，其中1176例（91.5%）经静脉取出滤器，24例（1.9%）经静脉取出失败后行开放手术取出IVC滤器，其中21例（1.6%）进行了随访并符合研究分析条件。对患者特征、滤器类型、滤器取出率、IVC通畅率及并发症进行回顾性分析。
21例患者的IVC滤器留置了26（10，37）个月，其中17例（81.0%）患者使用的是非锥形滤器，4例（19.0%）使用的是锥形滤器；所有21个滤器均成功取出，取出率为100%，无死亡、无严重并发症且无有症状的肺栓塞。在术后第3个月随访及抗凝治疗停止后第3个月随访时，仅1例（4.8%）出现IVC闭塞，但未出现新的下肢深静脉血栓形成及无症状性肺栓塞。
经静脉取出失败或伴有无肺栓塞症状的并发症时，开放手术可用于取出IVC滤器。开放手术方法可作为取出此类滤器的辅助临床干预措施。
