Li Richard Longfei, Voit Antanina, Commander Sarah Jane, Mureebe Leila, Williams Zachary
Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL.
Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC.
J Vasc Surg Venous Lymphat Disord. 2023 Nov;11(6):1175-1181. doi: 10.1016/j.jvsv.2023.06.009. Epub 2023 Jul 11.
Chronically indwelling inferior vena cava filters (IVCFs) can have multiple adverse sequelae, including IVCF-associated thrombosis. The Inari ClotTriever and FlowTriever mechanical and aspiration thrombectomy systems (Inari Medical) can be used for acute caval thrombosis associated with IVCFs if appropriate proximal IVCF protection is used intraprocedurally. The present study reports a single institution's outcomes after ClotTriever and FlowTriever thrombectomy of acute IVCF-associated iliocaval thrombus.
A retrospective review was conducted of all patients who underwent ClotTriever or FlowTriever thrombectomy for IVCF-associated caval thrombosis. The patient demographics, clinical characteristics, and postprocedural outcomes of a 15-patient cohort were compiled and described.
A total of 15 patients were identified as presenting with acute IVCF-associated caval thrombosis and having undergone intervention with either the ClotTriever or FlowTriever system from 2019 to 2022. Of the 15 patients in the cohort, 3 (20%) had presented with a threatened extremity (phlegmasia cerulea dolens), and 12 had presented with severe, debilitating, but non-limb-threatening, lower extremity edema. The preprocedural clot burden was significant and involved the cava, iliac veins, and femoropopliteal veins in 7 of 15 patients (47%) in the cohort. The procedure was technically successful in 11 patients (73.33%). Resolution of acute symptoms was noted in 100% of the technically successful procedures. The 30-day mortality rate was 13% (2 of 15 patients). One intraprocedural death occurred from pulmonary embolism, and one patient died of malignancy complications. The surviving patients not lost to follow-up experienced stable or improving venous disease, with only one patient presenting with post-phlebitic syndrome.
Mechanical and aspiration thrombectomy of IVCF-associated thrombus with the FlowTriever and ClotTriever systems have good technical success and resulted in significant improvement in acute symptoms with adequate clot clearance. Proximal embolic protection maneuvers for pulmonary embolism prophylaxis and preexisting filter protection are required intraprocedurally.
长期留置下腔静脉滤器（IVCF）可产生多种不良后果，包括与IVCF相关的血栓形成。如果在手术过程中使用适当的近端IVCF保护措施，Inari ClotTriever和FlowTriever机械及抽吸血栓清除系统（Inari Medical）可用于治疗与IVCF相关的急性腔静脉血栓形成。本研究报告了在一家机构中，对急性IVCF相关的髂股静脉血栓进行ClotTriever和FlowTriever血栓清除术后的结果。
对所有接受ClotTriever或FlowTriever血栓清除术治疗IVCF相关腔静脉血栓形成的患者进行回顾性研究。汇总并描述了一个包含15名患者的队列的患者人口统计学、临床特征和术后结果。
共有15名患者被确定为患有急性IVCF相关的腔静脉血栓形成，并在2019年至2022年期间接受了ClotTriever或FlowTriever系统的干预。在该队列的15名患者中，3名（20%）出现了肢体威胁（股青肿），12名出现了严重、使人衰弱但不威胁肢体的下肢水肿。术前血栓负荷较重，该队列中15名患者中有7名（47%）的腔静脉、髂静脉和股腘静脉均有血栓。11名患者（73.33%）手术在技术上成功。在所有技术成功的手术中，急性症状均得到缓解。30天死亡率为13%（15名患者中有2名）。1例术中死亡是由于肺栓塞，1例患者死于恶性肿瘤并发症。存活且未失访的患者静脉疾病稳定或改善，只有1例患者出现了血栓后综合征。
使用FlowTriever和ClotTriever系统对IVCF相关血栓进行机械及抽吸血栓清除术在技术上成功率较高，且能通过充分清除血栓使急性症状得到显著改善。术中需要采取近端栓塞保护措施以预防肺栓塞，并利用已有的滤器进行保护。
