Cotroneo A R, Di Stasi C, Cina A, Di Gregorio F
Istituto di Radiologia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.
Rays. 1996 Jul-Sep;21(3):461-80.
Interruption of vena cava for prevention of pulmonary embolism (PE) was achieved in the past with surgical ligation or placement of clips outside the infrarenal vena cava. At present, this procedure is performed with percutaneous insertion of vena cava filters. Vena cava filters can be permanent or temporary, catheter-retrievable. Main indications for placement of a vena cava filter are: contraindication for anticoagulant therapy in patients with severe PE in whom a further embolic episode would be fatal or patients with PE (or its recurrence) undergoing adequate anticoagulant therapy. Temporary filters are reserved to patients where the risk of PE is limited in time as in posttraumatic, post-partum or postoperative thromboembolism. The incidence of recurrence after placement of a vena cava filter varies between 0.5 and 7%. Procedure-associated complications are usually mild. However, severe complications as filter migration into the pulmonary artery or vena cava perforation were described. Our experience concerns the insertion of 61 vena cava filters (47 permanent and 14 temporary). Indications were as follows: iliofemoral thrombosis at embolic risk (37 cases), contraindication for anticoagulant therapy in the presence of deep vein thrombosis with embolic risk (7 cases), protection during fibrinolytic therapy (3 cases), PE during anticoagulant therapy (5 cases) complications of anticoagulant therapy which required discontinuation (5 cases), prophylaxis in view of surgery at high risk for PE (2 cases), protection for surgical venous thrombectomy (2 cases). Mortality was nil. Clinically evident PE was not observed in any patient in whom vena cava filter was inserted. Complications were mild and asymptomatic. Vena cava filters represent an effective prevention of PE together with medical and surgical treatment. At present, problems of this procedure are not technical but rather concern correct indications. Interruption of vena cava is effective if planned within a global strategy for prevention of thromboembolism.
过去，通过手术结扎或在肾下腔静脉外放置夹子来实现腔静脉阻断以预防肺栓塞（PE）。目前，该手术通过经皮插入腔静脉滤器来完成。腔静脉滤器可以是永久性的或临时性的、可通过导管取出的。放置腔静脉滤器的主要指征是：严重PE患者中抗凝治疗的禁忌证，进一步栓塞事件将是致命的，或接受充分抗凝治疗的PE（或其复发）患者。临时性滤器适用于PE风险在时间上有限的患者，如创伤后、产后或术后血栓栓塞。放置腔静脉滤器后复发的发生率在0.5%至7%之间。与手术相关的并发症通常较轻。然而，也有滤器迁移至肺动脉或腔静脉穿孔等严重并发症的报道。我们的经验涉及61个腔静脉滤器的插入（47个永久性和14个临时性）。指征如下：有栓塞风险的髂股静脉血栓形成（37例）、存在有栓塞风险的深静脉血栓形成时抗凝治疗的禁忌证（7例）、纤维蛋白溶解治疗期间的保护（3例）、抗凝治疗期间的PE（5例）、需要停用抗凝治疗的抗凝治疗并发症（5例）、鉴于有高PE风险的手术进行预防（2例）、手术静脉血栓切除术的保护（2例）。死亡率为零。在插入腔静脉滤器的任何患者中均未观察到临床明显的PE。并发症轻微且无症状。腔静脉滤器与药物和手术治疗一起是预防PE的有效方法。目前，该手术的问题不是技术问题，而是涉及正确的指征。如果在预防血栓栓塞的整体策略内进行规划，腔静脉阻断是有效的。
