Helmberger T, Helmberger R, Holzknecht N, Waggershauser T, Stäbler A, Reiser M
Institut für Radiologische Diagnostik, Klinikum Grosshadern, Ludwig-Maximilians-Universität München.
Radiologe. 1998 Jul;38(7):614-23. doi: 10.1007/s001170050400.
Pulmonary embolism is the third leading cause of death in the western countries. If anticoagulation fails or is contra-indicated, or if the risk for pulmonary embolism is increased for other reasons, the percutaneous implantation of a vena cava filter should be considered.
The available filters can be differentiated by the design (cone, basket, net-types), by the material, and by their removability. The rate of complications (caval thrombosis, fracture of filter) and the in vitro efficacy in trapping thrombotic clots is dependent on the specific filter type.
In clinical practice there is no evidence for significant differences in trapping efficacy among the different filters. About 4% of all patients treated by caval filters still can have pulmonary embolism, and 1% will have a fatal outcome. Dependent on the filter type, the most common complication is caval thrombosis, in up to 25% of cases.
The percutaneous implantation of caval filters can readily be performed by interventional radiologists. However, randomized clinical studies failed to clearly document efficacy of caval filters. Therefore, indication has to be considered carefully.
肺栓塞是西方国家第三大致死原因。如果抗凝治疗失败或存在禁忌，或者由于其他原因肺栓塞风险增加，则应考虑经皮植入下腔静脉滤器。
现有的滤器可根据设计（锥形、篮形、网形）、材料及其可移除性进行区分。并发症发生率（腔静脉血栓形成、滤器断裂）和体外捕获血栓性凝块的效果取决于特定的滤器类型。
在临床实践中，没有证据表明不同滤器在捕获效果上存在显著差异。接受腔静脉滤器治疗的所有患者中约4%仍可能发生肺栓塞，1%会有致命后果。根据滤器类型，最常见的并发症是腔静脉血栓形成，发生率高达25%。
介入放射科医生可轻松进行经皮植入腔静脉滤器操作。然而，随机临床研究未能明确证明腔静脉滤器的疗效。因此，必须谨慎考虑适应证。
