Pieri A, Santoro G, Duranti A, Mori F, Vannuzzi A, Benelli L
Sect. de Angiologie, UO de Cardiologie du Prof. G. De Saint-Pierre.
Phlebologie. 1993 Jul-Sep;46(3):457-66.
The AA. utilized temporary vena cava filters (16 Filcard and 8 Lysofilters) in 24 patients affected by deep venous thrombosis (DVT) of the lower limbs for the prevention of primary and recurrent pulmonary embolism (PE). The diagnosis of thromboembolic disease was always achieved by means of Ultrasounds (echo-color doppler) and was punctually confirmed by a retrograde cavagram during the insertion of the device. 19 patients presented large free-floating thrombi at inferior caval, iliac or common femoral vein level whereas 5 patients presented thrombi mostly of occlusive aspect. There was clinical or scintigraphic evidence of PE in 6 of the patients enrolled. 20 patients, without contraindications, were treated by fibrinolysis (F) with Urokinase (2-10 days) whereas 4 patients underwent surgical thrombectomy (T) because of short time relation with surgical intervention or trauma. All of them were protected by temporary vena cava filters and heparinized. All the filters were removed within 10 days. The results were considered "very good" (complete regression of floating thrombi) in 16 cases (14 F + 2 T), "good" (nearly complete regression of floating thrombi) in 3 cases (2 F + 1 T) and "poor" (unchanged) in the remaining 5 cases (4 F + 1 T). We didn't observe any new case or relapse of PE in the whole group and, furtherly, in 2 cases (1 F and 1 T) we demonstrated the capture of big emboli by the filter's basket. These clots were subsequently dissolved by fibrinolysis. To achieve the diagnosis of thromboembolic disease the following methods were used: 1--Screening: echo-color doppler of lower limbs extended to iliac and inferiora cava veins for detection of DVT and echocardio-color doppler for the detection of cardiac signs of PE. 2--DIAGNOSIS: pulmonary scintigram, retrograde cavogram and, rarely, angioCT scan. 3--FOLLOW-UP: echo-color doppler of lower limbs and pulmonary scintigram. The percutaneous insertion sites were the basilic vein (Filcard) and the right jugular vein (Lysofilter). Left jugular vein was used in 1 case with a big thyroid goitre. In the present experience we had no accidents during filters introduction or removal and no thrombosis at the insertion site (1 case of phlebitis of basilic vein). Indications and effectiveness: our results seem to be favorable to the use of inferior vena cava temporary filters for primary and recurrent pulmonary embolism prevention in the cases with floating thrombi both on fibrinolysis and embolectomy. In the cases of occlusive thrombotic diseases they proved to be effective to prevent PE during surgical embolectomy.(ABSTRACT TRUNCATED AT 400 WORDS)
该研究组对24例下肢深静脉血栓形成（DVT）患者使用了临时腔静脉滤器（16个Filcard和8个Lysofilter），以预防初次及复发性肺栓塞（PE）。血栓栓塞性疾病的诊断均通过超声（彩色多普勒）完成，并在置入装置时通过逆行腔静脉造影得以准确证实。19例患者在下腔静脉、髂静脉或股总静脉水平存在大量游离漂浮血栓，而5例患者的血栓大多呈闭塞性。入组患者中有6例有临床或闪烁扫描证据表明存在肺栓塞。20例无禁忌证的患者接受了尿激酶溶栓治疗（2 - 10天），而4例患者因与手术干预或创伤的时间关系较短而接受了手术取栓（T）。所有患者均使用临时腔静脉滤器并肝素化。所有滤器均在10天内取出。结果显示，16例（14例溶栓 + 2例手术取栓）为“非常好”（漂浮血栓完全消退），3例（2例溶栓 + 1例手术取栓）为“好”（漂浮血栓几乎完全消退），其余5例（4例溶栓 + 1例手术取栓）为“差”（无变化）。在整个研究组中，我们未观察到任何新的肺栓塞病例或复发情况，此外，在2例患者（1例溶栓和1例手术取栓）中，我们证实滤器篮捕获了大的栓子。这些血栓随后通过溶栓溶解。为明确血栓栓塞性疾病的诊断，采用了以下方法：1 - 筛查：下肢彩色多普勒超声检查扩展至髂静脉和下腔静脉以检测深静脉血栓形成，以及心脏彩色多普勒超声检查以检测肺栓塞的心脏体征。2 - 诊断：肺闪烁扫描、逆行腔静脉造影，很少使用血管CT扫描。3 - 随访：下肢彩色多普勒超声检查和肺闪烁扫描。经皮插入部位为贵要静脉（Filcard）和右颈静脉（Lysofilter）。1例甲状腺肿大明显的患者使用了左颈静脉。在本研究中，滤器置入或取出过程中未发生任何意外，插入部位也未发生血栓形成（1例贵要静脉静脉炎）。适应证和有效性：我们的结果似乎支持在溶栓和取栓治疗中，对于存在漂浮血栓的病例，使用下腔静脉临时滤器预防初次及复发性肺栓塞。在闭塞性血栓性疾病的病例中，它们被证明在手术取栓过程中预防肺栓塞是有效的。（摘要截选至400字）
