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下腔静脉滤器与并发症:一项系统评价

Inferior Vena Cava Filters and Complications: A Systematic Review.

作者信息

Bajda Joe, Park Ann N, Raj Aishwarya, Raj Rhea, Gorantla Vasavi Rakesh

机构信息

Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD.

Medicine, St. George's University School of Medicine, True Blue, GRD.

出版信息

Cureus. 2023 Jun 6;15(6):e40038. doi: 10.7759/cureus.40038. eCollection 2023 Jun.

Abstract

Inferior vena cava (IVC) filters have been used since the 1960s to treat patients with acute risk of pulmonary embolism (PE) to prevent migration of thrombus by trapping it within the filter. Traditional usage has been in patients with contraindication to anticoagulation that carry a significant mortality risk. In this systematic review, we sought to evaluate complications associated with placement of inferior vena cava filters based on published data from the past 20 years. A search was performed on October 6th, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews, using three databases (ProQuest, PubMed and ScienceDirect) for articles published between the dates of February 1, 2002 and October 1, 2022. Results were filtered to include full-text, clinical studies, and randomized trials written in English pertaining to keywords "IVC filter AND complications", "Inferior Vena Cava Filter AND complications", "IVC filter AND thrombosis" and "Inferior Vena Cava Filter AND thrombosis". Articles identified by the three databases were pooled and further screened for relevance based on inclusion and exclusion criteria. Initial search results yielded 33,265 hits from all three databases combined. Screening criteria were applied, with 7721 results remaining. After further manual screening, including removal of duplicate hits, a total of 117 articles were selected for review. While there are no consensus guidelines for best practice, there is compelling evidence that IVC filters can provide significant protection against PE with minimal complications if the treatment window is appropriate. Increase in the variety of filter models has led to broader availability, but skepticism remains about their efficacy and safety, with ongoing controversy surrounding appropriate indications. Further research is needed to establish clear guidelines on appropriate indications for IVC placement and to determine time course of complications versus benefits for indwelling filters.

摘要

自20世纪60年代以来,下腔静脉(IVC)滤器一直被用于治疗有急性肺栓塞(PE)风险的患者,通过将血栓截留在滤器内来防止其迁移。传统上,它用于对抗凝治疗有禁忌且存在重大死亡风险的患者。在本系统评价中,我们试图根据过去20年发表的数据评估与下腔静脉滤器置入相关的并发症。2022年10月6日,按照系统评价和Meta分析的首选报告项目(PRISMA)指南进行系统评价检索,使用三个数据库(ProQuest、PubMed和ScienceDirect)检索2002年2月1日至2022年10月1日发表的文章。结果经过筛选,纳入全文、临床研究以及用英文撰写的关于关键词“IVC滤器与并发症”、“下腔静脉滤器与并发症”、“IVC滤器与血栓形成”和“下腔静脉滤器与血栓形成”的随机试验。三个数据库识别出的文章进行汇总,并根据纳入和排除标准进一步筛选相关性。初步检索结果显示,三个数据库总共命中33265条。应用筛选标准后,剩余7721条结果。经过进一步人工筛选,包括去除重复命中结果,共选择117篇文章进行综述。虽然对于最佳实践尚无共识指南,但有令人信服的证据表明,如果治疗时机合适,IVC滤器能够以最小的并发症为PE提供显著保护。滤器型号的增加使得其可用性更广泛,但人们对其疗效和安全性仍持怀疑态度,关于合适适应证的争议仍在持续。需要进一步研究以建立关于IVC置入合适适应证的明确指南,并确定留置滤器并发症与益处的时间进程。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d44f/10243179/4613d91ba010/cureus-0015-00000040038-i01.jpg

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