Zwaan M, Lorch H, Kulke C, Kagel C, Schweider G, Siemens H J, Müller G, Eberhardt I, Wagner T, Weiss H D
Department of Radiology, Medical University of Lübeck, Germany.
J Vasc Interv Radiol. 1998 Jul-Aug;9(4):594-601. doi: 10.1016/s1051-0443(98)70328-8.
To look at the benefits and complications of different vena caval filters inserted prophylactically. Three temporarily implantable caval filter systems were used in 67 patients.
Twelve Cook filters (six transjugular, six transfemoral), 11 Angiocor filters (one transjugular, 10 transbrachial), and 44 Antheor filters (three transjugular, four transfemoral, 37 transbrachial) were successfully implanted. In known iliac vein or caval thrombosis, the prophylactic filters were placed during thrombolytic therapy in 46 cases, surgery in 17 cases, thrombosis in pregnancy in three cases, and high-dose heparinization without lysis in one case.
One patient had a fatal pulmonary embolism during treatment; seven thrombi were detected in the filter. Other complications were caused either by the underlying therapy alone (one fatal outcome of abdominal aorta aneurysmal surgery, two cases of cerebral hemorrhage, two cases of retroperitoneal hematomas, two cases of streptokinase fever reactions, one compartment syndrome, two cases of macrohematuria), by the combination of therapy and caval filter implantation (three cases of groin hematomas, three cases of arm hematomas), or by filter implantation alone (two cases of subclavian vein thrombosis, one catheter infection, one dislocation, one air embolism, one basket rupture). The bleeding complications were related to the aggressive thrombolytic therapy and would have occurred without filter implantation.
Because temporary caval filters have no long-term complications per se, their use seems sensible as long as there are stringent indications, including the presence of iliac vein or caval thrombosis and risk of thrombus mobilization. The Antheor filter system was the most convenient system for implantation.
探讨预防性植入不同腔静脉滤器的益处及并发症。67例患者使用了三种临时可植入的腔静脉滤器系统。
成功植入12枚库克滤器（6枚经颈静脉，6枚经股静脉）、11枚血管心滤器（1枚经颈静脉，10枚经肱静脉）和44枚安特奥滤器（3枚经颈静脉，4枚经股静脉，37枚经肱静脉）。在已知髂静脉或腔静脉血栓形成的情况下，46例在溶栓治疗期间放置预防性滤器，17例在手术期间放置，3例在妊娠期血栓形成时放置，1例在大剂量肝素化未溶栓时放置。
1例患者在治疗期间发生致命性肺栓塞；在滤器中检测到7处血栓。其他并发症要么仅由基础治疗引起（1例腹主动脉瘤手术致死，2例脑出血，2例腹膜后血肿，2例链激酶发热反应，1例骨筋膜室综合征，2例肉眼血尿），要么由治疗与腔静脉滤器植入联合引起（3例腹股沟血肿，3例手臂血肿），要么仅由滤器植入引起（2例锁骨下静脉血栓形成，1例导管感染，1例移位，1例空气栓塞，1例滤器篮破裂）。出血并发症与积极的溶栓治疗有关，即使不植入滤器也会发生。
由于临时腔静脉滤器本身无长期并发症，只要有严格的适应证，包括存在髂静脉或腔静脉血栓形成及血栓移动风险，使用它们似乎是合理的。安特奥滤器系统是最便于植入的系统。
