Tian Xuan, Liu Jianlong, Li Jinyong, Liu Xiao, Zhou Mi, Tian Yule
Department of Vascular Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
International Department, Experimental High School, Beijing Normal University, Beijing, China.
Front Cardiovasc Med. 2024 Jul 2;11:1412571. doi: 10.3389/fcvm.2024.1412571. eCollection 2024.
We report the case of a 22-year-old male who underwent endoluminal surgery and was implanted an Option Elite filter in the superior vena cava (SVC) while the filter retraction hook was attached to the vessel wall. The patient requested to remove the filter after 155 days. Preoperative ultrasonography and CT examination revealed that the filter retraction hook was very likely to penetrate the SVC wall and its tip was very close to the right pulmonary artery. The SVC was not obstructed, and no thrombus was observed in either upper limb. After the filter retrieval device (ZYLOX, China) failed to capture the filter hook, we introduced a pigtail catheter with its tip partly removed and a loach guidewire, used a modified loop-snare technique to cut the proliferative tissues and free the hook, and finally removed the filter successfully by direct suspension of the guidewire. During this procedure, the patient experienced discomfort, such as chest pain and palpitations, but these symptoms disappeared when procedure completed. Repeated multiangle angiography revealed no contrast medium extravasation, no complications such as pericardial tamponade, pleural effusion, SVC haematoma formation, right pulmonary artery dissecting aneurysm, or intramural haematoma. We initially presented the modified loop-snare technique used to remove a conical superior vena cava filter (SVCF), so this method can be considered a practical and novel auxiliary technique for successful filter retrieval.
我们报告了一例22岁男性患者的病例，该患者接受了腔内手术，在过滤器回收钩附着于血管壁的情况下，在上腔静脉（SVC）植入了一枚Option Elite过滤器。155天后患者要求取出过滤器。术前超声检查和CT检查显示，过滤器回收钩极有可能穿透SVC壁，其尖端非常靠近右肺动脉。SVC未受阻，双上肢均未观察到血栓。在过滤器回收装置（中国ZYLOX）未能捕获过滤器钩后，我们引入了顶端部分切除的猪尾导管和泥鳅导丝，采用改良圈套技术切断增生组织并松解钩子，最终通过直接悬吊导丝成功取出过滤器。在此过程中，患者出现了胸痛、心悸等不适症状，但手术结束后这些症状消失。反复多角度血管造影显示无造影剂外渗，未出现心包填塞、胸腔积液、SVC血肿形成、右肺动脉夹层动脉瘤或壁内血肿等并发症。我们首次介绍了用于取出锥形上腔静脉过滤器（SVCF）的改良圈套技术，因此该方法可被视为一种实用且新颖的辅助成功取出过滤器的技术。
