Whitehill T A
Department of Surgery, University of Colorado Health Sciences Center, Denver, 80262, USA.
Semin Vasc Surg. 1996 Mar;9(1):59-69.
The Stainless Steel and Titanium Greenfield filters, the Venatech filter, and the Bird's nest filter are most commonly used in the United States. A comparison of contemporary experience with these filters along with that of Simon-Nitinol filter is shown in Table 1. The published experience with each device is minimal compared with actual clinical use. The published reports available do not often examine experience with a view toward unbiased and accurate comparison of results. Each filter has an acceptably low rate of recurrent PE, but each has experienced the range of complications associated with vena caval filters or partitions. The reviewed case series are too small and the complication rates too similar for any of the newer designs to claim unequivocal superiority. Except for the Stainless Steel Greenfield filter, comparison is further complicated by the lack of standardized, quantitative follow-up of patients over a period long enough for possible extremity venous complications to be observed. Each of the currently available filters has at least one specific attribute that may recommend it for a particular situation. Detailed and comparable examination of IVC filtration is becoming more important as the indication for and use of these devices increase. Clearly, the search for the perfect device to prevent PE should continue.90 Any filtration device plays only a small role in the overall management of the patient with thromboembolic disease. It is incumbent upon the physician who treats this patient to assume the responsibility for the diagnosis of and long-term follow-up of the underlying disorder. Considerable technical ingenuity and continued evolution of materials and design have propelled the development and number of available vena cava filters for clinical use. Without objective clinical data, many interventional radiologists and surgeons base their filter selection on ease of insertion and device cost. Variable data on safety and effectiveness demand that physicians match the best filter to each patient's particular situation and anatomy. The primary objective of vena cava filtration is to provide a safe and effective device for permanent implantation. If this objective is not kept in sight, quality of care in the management of deep venous thrombosis and/or pulmonary embolus will be lost.
在美国，不锈钢和钛制的格林菲尔德滤器、维纳泰克滤器以及鸟巢式滤器最为常用。表1展示了当代使用这些滤器以及西蒙镍钛诺滤器的经验对比情况。与实际临床应用相比，每种设备已发表的经验都很少。现有的已发表报告往往并非从无偏且准确比较结果的角度来审视经验。每种滤器的复发性肺栓塞发生率都低到可以接受，但每种滤器都出现过与腔静脉滤器或分隔装置相关的一系列并发症。所回顾的病例系列规模太小，且对于任何一种新型设计而言，其并发症发生率都太过相似，以至于无法宣称具有明确的优越性。除了不锈钢格林菲尔德滤器外，由于缺乏对患者进行足够长时间的标准化、定量随访以观察可能出现的肢体静脉并发症，使得对比进一步复杂化。目前可用的每种滤器都至少有一个特定属性，这可能使其适用于特定情况。随着这些设备的适应证和使用增加，对下腔静脉滤过进行详细且可比的检查变得越发重要。显然，寻找预防肺栓塞的完美设备的工作应继续下去。90任何滤过设备在血栓栓塞性疾病患者的整体治疗中所起的作用都很小。治疗此类患者的医生有责任对潜在疾病进行诊断并进行长期随访。相当的技术独创性以及材料和设计的不断发展推动了临床可用腔静脉滤器的开发和数量增加。由于缺乏客观的临床数据，许多介入放射科医生和外科医生根据插入的难易程度和设备成本来选择滤器。关于安全性和有效性的可变数据要求医生根据每个患者的具体情况和解剖结构选择最佳滤器。腔静脉滤过的主要目标是提供一种安全有效的永久性植入设备。如果忽视这一目标，在深静脉血栓形成和/或肺栓塞的治疗中就会失去医疗质量。
