Starok M S, Common A A
Department of Medical Imaging, University of Toronto, Ontario.
Can Assoc Radiol J. 1996 Jun;47(3):189-94.
To determine the long-term clinical and radiographic outcome of patients who undergo insertion of a Gianturco-Roehm Bird's Nest vena caval filter (Cook Inc., Bloomington, Ind.).
The medical records of 40 patients who, over a 34-month period, underwent insertion of a Bird's Nest filter were reviewed and the reasons for filter insertion determined. The causes of any subsequent deaths were noted, and the autopsy findings, when available, were reviewed. Surviving patients were contacted, and 12 were willing to return for follow-up imaging, which consisted of plain radiography, real-time ultrasonography, colour Doppler imaging and contrast-enhanced computed tomography. Changes in filter position, the presence of thrombus and perforation of the vessel wall by the filter struts were documented.
All 10 patients who underwent filter insertion while in an intensive care unit (ICU) died, an average of 22 days after the procedure. Eleven other patients also died. Recurrent pulmonary embolism was not suspected in any of these patients, and five autopsies revealed no caval thrombosis. Imaging studies in 12 of the surviving patients revealed no occlusion of the inferior vena cava and no filter migration; however, the vena caval wall was perforated in all of these patients. Nonocclusive intrafilter thrombus was detected by colour Doppler imaging in three patients.
In this small group of patients the Bird's Nest filter was effective in preventing recurrent pulmonary embolism and caused less caval thrombosis than has previously been suspected, although intrafilter clot was found in 25% of the patients who underwent follow-up imaging. Colour Doppler imaging is the method of choice for detecting nonocclusive thrombus with this type of filter. Perforation of the caval wall was universal but not clinically symptomatic. Finally, guidelines should be established to ensure the cost-effective use of inferior vena caval filters in ICU patients.
确定植入Gianturco-Roehm鸟巢式腔静脉滤器（库克公司，印第安纳州布卢明顿）患者的长期临床和影像学结局。
回顾了40例在34个月期间植入鸟巢式滤器患者的病历，并确定了植入滤器的原因。记录任何后续死亡的原因，并在有尸检结果时进行回顾。联系了存活患者，其中12例愿意返回接受随访成像，包括X线平片、实时超声、彩色多普勒成像和增强CT。记录滤器位置的变化、血栓的存在以及滤器支柱对血管壁的穿孔情况。
在重症监护病房（ICU）植入滤器的所有10例患者均死亡，平均在术后22天。另外11例患者也死亡。这些患者均未怀疑有复发性肺栓塞，5例尸检未发现腔静脉血栓形成。12例存活患者的影像学检查未发现下腔静脉闭塞和滤器移位；然而，所有这些患者的腔静脉壁均有穿孔。彩色多普勒成像在3例患者中检测到滤器内非闭塞性血栓。
在这一小群患者中，鸟巢式滤器可有效预防复发性肺栓塞，且引起的腔静脉血栓形成比之前怀疑的要少，尽管在接受随访成像的患者中有25%发现滤器内有血栓形成。彩色多普勒成像是检测此类滤器内非闭塞性血栓的首选方法。腔静脉壁穿孔普遍存在，但无临床症状。最后，应制定指南以确保在ICU患者中经济有效地使用下腔静脉滤器。
