Kang Richard D, Schuchardt Philip, Charles Jonathan, Kumar Premsai, Drews Elena, Kazi Stephanie, DePalma Andres, Fang Adam, Raymond Aislynn, Davis Cliff, Massis Kamal, Hoots Glenn, Mhaskar Rahul, Nezami Nariman, Shaikh Jamil
University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
Department of Radiology, University of South Florida Health, Tampa General Hospital, Tampa, FL, USA.
CVIR Endovasc. 2023 Nov 11;6(1):55. doi: 10.1186/s42155-023-00392-9.
Endobronchial forceps are commonly used for complex IVC filter removal and after initial attempts at IVC filter retrieval with a snare have failed. Currently, there are no clear guidelines to help distinguish cases where primary removal should be attempted with standard snare technique or whether attempts at removal should directly be started with forceps. This study is aimed to identify clinical and imaging predictors of snare failure which necessitate conversion to endobronchial forceps.
Retrospective analysis of 543 patients who underwent IVC filter retrievals were performed at three large quaternary care centers from Jan 2015 to Jan 2022. Patient demographics and IVC filter characteristics on cross-sectional images (degree of tilt, hook embedment, and strut penetration, etc.) were reviewed. Binary multivariate logistic regression was used to identify predictors of IVC filter retrieval where snare retrieval would fail.
Thirty seven percent of the patients (n = 203) necessitated utilization of endobronchial forceps. IVC filter hook embedment (OR:4.55; 95%CI: 1.74-11.87; p = 0.002) and strut penetration (OR: 56.46; 95% CI 20.2-157.7; p = 0.001) were predictors of snare failure. In contrast, total dwell time, BMI, and degree of filter tilt were not associated with snare failure. Intraprocedural conversion from snare to endobronchial forceps was significantly associated with increased contrast volume, radiation dose, and total procedure times (p < 0.05).
IVC filter hook embedment and strut penetration were predictors of snare retrieval failure. Intraprocedural conversion from snare to endobronchial forceps increased contrast volume, radiation dose, and total procedure time. When either hook embedment or strut penetration is present on pre-procedural cross-sectional images, IVC filter retrieval should be initiated using endobronchial forceps.
Level 3, large multicenter retrospective cohort.
支气管内钳常用于复杂的下腔静脉滤器取出术，以及初次尝试用圈套器取出下腔静脉滤器失败后。目前，尚无明确的指南来帮助区分哪些情况应首先尝试用标准圈套器技术取出，或者是否应直接开始用钳子进行取出尝试。本研究旨在确定圈套器取出失败从而需要改用支气管内钳的临床和影像学预测因素。
对2015年1月至2022年1月在三个大型四级医疗中心接受下腔静脉滤器取出术的543例患者进行回顾性分析。回顾了患者的人口统计学资料以及横断面图像上的下腔静脉滤器特征（倾斜度、钩嵌入情况、支柱穿透情况等）。采用二元多因素逻辑回归分析来确定圈套器取出失败的预测因素。
37%的患者（n = 203）需要使用支气管内钳。下腔静脉滤器钩嵌入（比值比：4.55；95%置信区间：1.74 - 11.87；p = 0.002）和支柱穿透（比值比：56.46；95%置信区间：20.2 - 157.7；p = 0.001）是圈套器取出失败的预测因素。相比之下，总留置时间、体重指数和滤器倾斜度与圈套器取出失败无关。术中从圈套器改用支气管内钳与造影剂用量增加、辐射剂量增加和总手术时间延长显著相关（p < 0.05）。
下腔静脉滤器钩嵌入和支柱穿透是圈套器取出失败的预测因素。术中从圈套器改用支气管内钳会增加造影剂用量、辐射剂量和总手术时间。当术前横断面图像上出现钩嵌入或支柱穿透时，应使用支气管内钳开始下腔静脉滤器取出术。
3级，大型多中心回顾性队列研究。
