Neuzil D F, Garrard C L, Berkman R A, Pierce R, Naslund T C
Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tenn. 37232-2735, USA.
Surgery. 1998 Apr;123(4):470-4.
Fluoroscopy, cost, and patient transport contribute to difficulties occasionally associated with the placement of vena caval filters. Follow-up data in the literature document the use of duplex ultrasonography in visualizing the filter and determining caval patency. Filter placement at the bedside or in the vascular laboratory with duplex ultrasonography may simplify this common procedure. We have attempted to define the feasibility of this method.
Patients referred to the vascular surgery service for vena caval interruption were evaluated for ability to visualize the renal veins and inferior vena cava. Location of renal veins, maximum diameter of the vena cava, and presence or absence of thrombus were documented. If visualization was adequate, placement was performed at the bedside for patients in intensive care or in the vascular laboratory for nonmonitored patients. The initial 10 patients and subsequent patients in whom there was a question of adequate deployment underwent completion abdominal roentgenography. Patient follow-up was difficult. Duplex ultrasonography was used to assess migration, thrombus adherent to the filter, and vena caval patency. Patients in whom filter placement was prophylactic were given anticoagulants at the discretion of the primary physician. Inadequate visualization or vena caval size greater than 28 mm prompted fluoroscopic placement of the vena caval filter, because only Greenfield titanium filters were used in the study.
Twenty-nine patients were referred for vena caval interruption. Inadequate visualization occurred in four obese patients, and filters were placed by fluoroscopy. There were no vena caval measurements greater than 24 mm. Twenty-five filters were placed without technical difficulty. One filter tilted into the right renal vein, requiring a suprarenal filter placed by fluoroscopy. Patient retrieval for follow-up has been difficult, but by ultrasonography there has been one vena caval thrombosis and no major filter migration. There have been no reported pulmonary emboli other than the one patient with initial tilt of the filter.
Placement of vena caval filters is feasible with duplex ultrasonography. Visualization is the only limiting condition to placement and occurs rarely. Reducing the need for fluoroscopy, lowering costs, and not needing to transport the critically ill patient support the use of this system. Intravascular ultrasonography in selected patients may eliminate the need for fluoroscopic placement of vena caval filters.
荧光透视检查、费用以及患者转运偶尔会给腔静脉滤器的放置带来困难。文献中的随访数据记录了使用双功超声来观察滤器并确定腔静脉通畅情况。在床边或血管实验室借助双功超声进行滤器放置可能会简化这一常见操作。我们试图确定该方法的可行性。
因腔静脉阻断而转诊至血管外科的患者接受评估，以确定能否观察到肾静脉和下腔静脉。记录肾静脉的位置、下腔静脉的最大直径以及血栓的有无。如果观察效果良好，对于重症监护患者在床边进行放置，对于非监护患者在血管实验室进行放置。最初的10例患者以及后续放置情况存疑的患者均接受了腹部X线检查。对患者的随访存在困难。使用双功超声评估滤器移位、滤器上附着的血栓以及腔静脉通畅情况。对于预防性放置滤器的患者，由主治医师酌情给予抗凝剂。观察效果不佳或腔静脉直径大于28 mm时，需通过荧光透视放置腔静脉滤器，因为本研究仅使用了格林菲尔德钛制滤器。
29例患者因腔静脉阻断而转诊。4例肥胖患者观察效果不佳，通过荧光透视放置了滤器。没有腔静脉直径大于24 mm的情况。25个滤器的放置没有技术困难。1个滤器倾斜进入右肾静脉，需要通过荧光透视放置一个肾上滤器。对患者进行随访存在困难，但通过超声检查发现有1例腔静脉血栓形成，且没有滤器严重移位。除了滤器最初倾斜的那例患者外，没有其他肺栓塞的报告。
借助双功超声放置腔静脉滤器是可行的。观察效果是放置的唯一限制条件，且很少出现。减少对荧光透视的需求、降低费用以及无需转运重症患者均支持使用该系统。对部分患者进行血管内超声检查可能无需通过荧光透视放置腔静脉滤器。
