下腔静脉滤器在创伤并下肢深静脉血栓中的应用

目的评价下腔静脉滤器(IVCF)在创伤合并下肢深静脉血栓形成(DVT)患者中的效用。方法回顾性分析52例创伤合并DVT患者的临床资料,术前植入可回收IVCF,分别为Aegisy滤器(29例)及Denali滤器(23例),Ⅱ期取出联合经皮机械性吸栓治疗,分析患者总体数据,并比较两组患者的差异。结果患者平均年龄53.31±14.03岁,IVCF植入及取出成功率100%,无肺栓塞(PE)发生,19例回收滤器中可见血栓,总体并无IVCF断裂,移位,穿孔,血栓形成的发生,2例Aegisy滤器出现倾斜,但均安全取出。两种滤器操作均较为顺利,IVCF植入及回收的平均操作时间及透视时间并未明显差异。结论可回收IVCF植入对于创伤合并DVT患者安全有效,可确保骨科手术及二期血栓清除的安全进行。     

肾静脉导丝定位在引导IVC滤器置入中的作用

目的 探讨肾静脉导丝定位的可行性及其在引导下腔静脉滤器(IVCF)置人中的作用.方法 对35例需要IVCF置入的患者行肾静脉导丝定位,确定IVCF放置位置,然后进行碘剂下腔静脉造影对照,判断定位的准确性和安全性.结果 造影证实35例患者导丝均成功进入双侧肾静脉,在肾静脉导丝定位引导下置入的IVCF头端距低位肾静脉下缘均在0～10 mm内;其中23例于2周后将滤器取出,1例因滤器上血栓大于3 mm未同收,2例因滤器下下腔静脉发现血栓未回收,其余9例因年龄大及患者拒绝末进行回收.随访1～22个月,无并发症发生.结论 肾静脉导丝定位在特殊情况下不失为一种较好的替代造影定位的方法.     

下腔静脉滤器置放术在深静脉血栓-肺栓塞演变中的临床应用

目的探讨下腔静脉滤器(IVCF)在预防深静脉血栓(DVT)-肺栓塞(PE)演变中的临床应用价值。方法经造影和(或)彩色多普勒超声证实为下肢深静脉广泛血栓30例,其中有肺部临床表现21例,胸部影像学证实19例,DSA显示下腔静脉内血栓6例。溶栓介入治疗前置放IVCF 30例,下腔静脉内血栓形成未放IVCF 1例。置放IVCF后经患肢足背静脉滴注尿激酶或经导管血栓内抽吸、局部溶栓、导丝搅拌增加溶栓接触面积;经非患肢静脉给予抗凝、抗生素治疗。结果本组30例放置5种构型滤器32枚,其中2枚为临时滤器,置入取出均顺利,滤器无移位,术中无并发症。痊愈9例,有效14例,改善6例,无效1例。因没有及时置入IVCF进行溶栓治疗,深静脉血栓导致下腔静脉血栓6例,后置入IVCF 5例疗效良好,未放IVCF 1例,12天后因肺栓塞死亡。结论下腔静脉滤器对预防深静脉血栓向肺栓塞演变具有一定价值,其置放术安全可靠,便于临床及时溶栓抗凝治疗,但其应用价值需进行综合评价和进一步探讨。     

下腔静脉滤器植入术67例临床分析

目的探讨下腔静脉滤器（inferior vena cava filter,IVCF）在下肢深静脉血栓形成中预防肺栓塞的应用。方法回顾性分析67例为预防肺栓塞放置下腔静脉滤器的临床资料。结果本组65例一次植入成功,1例因血管变异改变植入入路后成功,1例因下腔静脉血栓形成放弃植入。37例（55．2％）为永久性滤器植入,30例（43．3％）为临时性滤器植入。永久性滤器患者随访32例,平均时间14．5（6—32）个月。8例患者出现不同程度近心端移位,其中1例移位显著予取出。所有放置滤器患者均无继发PE发生。未发现腔静脉继发性血栓形成。结论腔静脉滤器植入是预防肺栓塞安全、有效的方法,存在一定并发症发生风险。应尽可能留置临时性滤器以降低远期并发症发生。     

下腔静脉滤器的应用与研究进展

深静脉血栓形成（DVT）是血液在深静脉内异常凝结导致的静脉回流障碍性疾病,常发生于下肢。栓子脱落可引起肺动脉栓塞（PE）,DVT与PE统称为静脉血栓栓塞症（VTE）,是同种疾病在不同阶段的表现形式。DVT的高发病率及并发PE导致的猝死风险已受到临床医生的密切关注,当VTE患者出现抗凝禁忌或抗凝治疗失败时,可置入下腔静脉滤器（IVCF）,通过其网状过滤结构捕获血凝块从而预防致死性PE发生。IVCF现已在全球广泛被应用,根据使用情况,可分为永久型、临时型及可选择回收型。永久型IVCF置入人体后除非手术切开腔静脉否则无法取出,远期滤器断裂、移位、栓塞、症状性下腔静脉穿孔等出现率较高,现已被临床淘汰;临时型IVCF通过与外部的导管和固定设备相接,便于回收但易于感染,临床应用极少;可回收型IVCF具有用于回收的钩状结构,当患者VTE风险期过后,可通过介入手术取出,是目前临床应用的主要类型,但由于部分患者VTE治疗时间超过了滤器留置时间窗,从而引起一系列并发症以及患者随访丢失等原因,导致实际回收率较低,相关争议日益增多。同时新型IVCF的研发正在紧密开展,药物洗脱IVCF使用抗平滑肌增生、抗炎等药物涂覆,可阻止血管内膜的过度增生,延长IVCF的留置时间以便于回收;可转换IVCF允许滤器结构在体内发生转换,由过滤网变形为开放式支架,以期降低远期并发症,但转换后的金属支架无法取出,对腔静脉的远期影响仍需要长期的随访观察;生物可降解IVCF可完全被机体吸收,避免了二次手术,是目前国内外学者研究的热点,但如何设计材料,保证滤器所拦截的血栓吸收之前IVCF保持应有的强度,进而防止血凝块或降解片段再次栓塞的问题目前没有明确的研究数据证实,拥有可控降解特点的新型IVCF是一个明确的研发目标。另一方面,部分学者通过计算机仿真模拟分析不同结构的过滤单元以及不同支撑杆数目对滤器性能的影响,为结构最优化、血流动力学影响最小化的新型IVCF研究提供了更科学的参考与理论依据。综上所述,在倡导推广应用更细致的患者管理和临床随访来提高IVCF取出率的基础上,进一步研发出一款理想的IVCF迫在眉睫,意义重大。新型IVCF应具备以下功能：可有效拦截血凝块,以防止新发或复发PE;在VTE高风险期结束后可远程控制转换或整体同步降解;滤器固定良好,保持良好的径向支撑性能同时不损伤腔静脉壁;具有良好生物相容性;对血流动力学影响较小;可在影像学检查中清晰显影便于随访。相信随着材料学、组织工程领域的深入研究与发展,可早日研制出临床疗效优异、并发症极少的新型IVCF。     

可调弯鞘联合一次性活检钳回收下腔静脉滤器的技巧与临床应用

目的 探讨可调弯鞘联合一次性活检钳在回收下腔静脉滤器中的技巧与临床应用.方法 我院2017年12月～2020年12月回收下腔静脉滤器117例,术中均采用可调弯鞘联合一次性活检钳技术,成功将滤器回收,术后观察随访.结果 117例进行腔静脉滤器(Aegisy滤器103例,Optease滤器9例,Günther Tulip滤...     

建立下腔静脉滤器应用新理念

下腔静脉滤器(IVCF)置入可以安全有效的降低肺栓塞发病率,但是长期置入的并发症也是显而易见的。理想IVCF的基本特点应包括血栓捕获的有效性、腔静脉壁的安全固定、并发症少、成本低等因素,因此医生应对各种IVCF的特点均有所了解,建立IVCF应用新理念,加强管理,重视回收。     

不同回收组套回收超长期时间窗OptEase下腔静脉滤器效果

目的观察Cook回收组套回收超长期时间窗OptEase下腔静脉滤器的效果。方法回顾性分析289例接受OptEase可回收下腔静脉滤器取出术患者,242例于正常时间窗(置入滤器14天内)回收滤器,其中127例(A组)使用OptEase回收组套、115例(B组)使用Cook回收组套;47例于超长期时间窗(滤器置入28天)回收,其中22例使用OptEase回收组套(C组)、25例使用Cook回收组套(D组)。比较A组与B组、C组与D组滤器回收成功率、回收时间及并发症发生率。结果 A、B组均成功回收滤器,2组间滤器回收时间、并发症发生率差异均无统计学意义(P均0.05)。D组滤器回收成功率高于C组(P0.05),回收时间及并发症发生率均低于C组(P均0.05)。各组均未见严重并发症。结论 Cook滤器回收组套用于回收超长期时间窗OptEase下腔静脉滤器效果较好。     

新型可回收下腔静脉滤器的动物实验研究

目的通过动物实验评估新型可回收下腔静脉（IVC）滤器的滤过效果、稳定性、安全性及可回收性。方法中华小型猪26只,急性实验组7只,考查滤器在体内的释放及回收情况以及滤过效果和稳定性;长期观察组19只,分为A、B两组,A组5只,B组14只,考查滤器在体内的稳定性、致栓倾向、可回收性以及置入不同时间段（10～60天）IVC壁的病理改变。结果急性实验组共进行19次释放及15次回收,操作均顺利完成,其中一枚滤器脚进入左肾静脉,位置明显偏斜,其余滤器位置均无明显移动及偏斜。长期观察组释放过程均顺利完成,滤器无明显偏斜,除40天后一枚滤器脚位于血管轮廓外,未进行回收。正位测量猪IVC直径为1.6～2.2 cm,平均（1.85±0.17）cm。病理检查示：10天后IVC内膜轻度增厚;20天后滤器脚已被血管内膜覆盖,内膜中度增厚;30～60天后,内膜明显增厚。结论新型可回收IVC滤器滤过效果可靠,释放及回收简便,在动物体内使用安全,可回收期限可达60天。     

下腔静脉滤器开放手术取出的安全性与可行性分析

背景和目的：下腔静脉滤器（IVCF）在预防致死性肺栓塞（PE）中广泛应用,通常经过腔内介入手段取出。对于腔内取出失败或超回收时间窗的滤器,可考虑手术取出。本研究目的是评价开放手术取出IVCF的安全性及可行性。方法 回顾性分析2019年2月—2022年8月在北京积水潭医院血管外科收治的27例IVCF置入后行开放手术取出的患者临床资料。所有患者开放手术前行介入尝试取出的中位次数为1（1~2）次。结果 所有滤器均全部取出,技术成功率为100%,滤器置入中位时间为20（5~48）个月。其中,Aegisy滤器8例（29.6%）,Denali滤器1例（3.7%）,Cordis滤器10例（37.0%）,Simon滤器1例（3.7%）,Celect滤器3例（11.1%）,Tulip滤器4例（14.8%）。1例（3.7%）滤器位于肾静脉上下腔静脉,1例（3.7%）位于肝后下腔静脉,25例（92.6%）滤器位于肾静脉下下腔静脉。术中,2例（7.4%）于滤器回收钩处留置荷包缝合线,未阻断下腔静脉血流,通过直接钳夹回收钩取出,取出后进行荷包缝合;2例（7.4%）未阻断下腔静脉血流,将滤器直接回收至血管鞘后行荷包缝合;1例（3.7%）阻断双肾静脉及滤器远近端下腔静脉血流,1例（3.7%）分别阻断滤器远端下腔静脉、第一肝门及第二肝门血流,21例（77.8%）阻断滤器远近端下腔静脉血流,然后通过切开下腔静脉前壁进行滤器取出,取出后进行血管壁连续缝合。手术平均时间为（224.15±23.85）min。围手术期无下肢深静脉血栓或症状性PE发生,无心肺系统并发症,无伤口感染。1例（3.7%）出现腹痛伴血性胃液,1例（3.7%）出现血尿,均保守对症治疗后缓解。术前血红蛋白平均为（128.59±15.05）g/L,术后为（110.56±22.15）g/L,6例（22.2%）术后输入悬浮红细胞400 mL,未见致命性大出血及休克。中位术后住院时间9（8~12）d。结论 尽管开放手术滤器取出手术难度较大、技术十分复杂,但滤器取出是安全可行的。术前充分利用CT判断滤器及其回收钩的位置,采用合适的手术方式,通过熟练的手术技巧可以极大地提高开腹手术的安全性和成功率。     

OptEase retrievable inferior vena cava filter: initial multicenter experience

The purpose of this article is to describe our experience with the retrievable OptEase inferior vena cava filter (IVCF) (Cordis Corporation, Miami Lakes, FL) in the prevention of pulmonary embolus (PE). Forty patients (24 men, age range 15-85 years, mean age 38 years) who were at temporary risk of PE underwent insertion and retrieval of the OptEase IVCF at two institutions. Eleven patients were treated with filter implantation and subsequent repositioning in the inferior vena cava (IVC) to extend implantation time. All patients were followed up for 24 hours after retrieval, with additional follow-up at the physician's discretion. Forty patients had successful filter insertion. Two patients who underwent intravascular ultrasound guidance for filter deployment required filter repositioning within 24 hours owing to inadvertent placement in the right common iliac vein. All 40 patients underwent successful filter retrieval with no adverse events. In those patients who did not undergo IVCF repositioning, the time to retrieval ranged from 3 to 48 days (mean +/- SD 16.38 +/- 7.20 days). One patient had a successful retrieval at 48 days, but all other retrieval experiences were performed within 23 days. The second strategy involved implantation, with repositioning at least once before final retrieval. This latter strategy occurred in 11 patients, and the time to first capture ranged from 4 to 30 days (mean +/- SD 13.82 +/- 6.13 days). No symptomatic PE, IVC injury or stenosis, significant bleeding, filter fracture, or filter migration was observed. In this feasibility study, the OptEase IVCF prevented symptomatic PE, was safely retrieved or repositioned up to 48 days after implantation, and served as an effective bridge to anticoagulation. In patients who require extended IVCF placement, the OptEase IVCF can be successfully repositioned within the IVC, thereby extending the overall implantation time of this retrievable IVCF.     

复杂可回收下腔静脉滤器回收的方法和技巧：附29例分析

目的:探讨复杂可回收下腔静脉滤器回收的方法和技巧。方法:回顾性分析29例复杂滤器回收的下肢深静脉血栓形成患者资料。所有患者均先行造影了解滤器情况;对回收钩贴壁患者,分别采用猪尾管支撑技术、导丝成攀及搅拌技术、双向导丝技术、鹅颈抓捕器与成攀导丝结合技术等回收;对下腔静脉继发血栓患者,必要时再次新置滤器1枚,经溶栓、吸栓处理后,将滤器回收。结果:成功回收24例,1例患者滤器未能成功回收,4例放弃,回收率83.9%。术中无下腔静脉破裂出血、肺栓塞并发症,取出滤器完整、无折断现象。至少随访半年,下腔静脉血流通畅、无血栓形成,腹腔无明显积液。结论:导管、导丝及鹅颈抓捕器辅助,溶栓、吸栓等方法可增加复杂可回收下腔静脉滤器回收率,可减少长期留置引起相关并发症。     

提高下腔静脉滤器回收率核心要点

静脉血栓栓塞症是院内常见的致死性心血管疾病之一,应用下腔静脉滤器能大幅度降低致死性肺栓塞的发生率,同时下腔静脉滤器长期植入带来的相关并发症不可忽视。越来越多的指南推荐当肺栓塞风险可控时应及时回收腔静脉滤器。但是由于临床理念与技术发展差异,临床上下腔静脉滤器的总体回收率并不高,大多数滤器最终还是永久性植入。减少滤器的并发症并大幅度提高下腔静脉滤器回收率须做到以下3点：（1）明确植入指征,严格选择,规范操作,精准植入。（2）植入后对滤器进行系统监测,及时处理原发血栓,充分抗凝。（3）有效处理滤器内血栓,回收技术规范化,充分利用多种介入技术提高回收率。     

Celect滤器回收困难病例的取出技巧

目的探讨复杂性回收钩贴壁下腔静脉滤器的取出技巧及应用策略。方法收集因滤器回收钩贴壁、采用Günther Celect配套回收装置无法成功取出Celect下腔静脉滤器9例,采用交换导丝成襻法行下腔静脉滤器取出术。结果 9例患者,最长植入时间为142天,最短37天,平均(88.67±33.85)天。使用交换导丝成襻法8枚滤器成功取出,1例患者因下腔静脉严重弯曲致回收失败,滤器回收成功率为88.89%(8/9)。滤器回收耗时57~162min,平均(69.89±12.12)min。所有滤器取出后形态完整,术后下腔静脉造影复查未见管壁穿孔,对比剂外渗。结论采用交换导丝成襻法可有效提高回收钩贴壁下腔静脉滤器成功回收率,具有一定的临床应用价值。     

Real-time intravascular ultrasound-guided placement of a removable inferior vena cava filter

BACKGROUND: Reports have demonstrated the benefit of prophylactic inferior vena cava filter (IVCF) placement to prevent pulmonary embolism. This series evaluates the potential for the bedside placement of a removable IVCF under "real-time" intravascular ultrasound (IVUS) guidance. METHODS: Twenty trauma patients underwent intensive care unit placement of a removable IVCF with IVUS guidance. All patients had ultrasonography of the femoral veins after placement to rule out postprocedure femoral vein thrombosis and radiographs to identify filter location. RESULTS: Nineteen of 20 IVCFs were placed at approximately the L2 level as verified by radiography. One patient had a large IVC (34 mm) and underwent bilateral common iliac IVCF placement under IVUS. Within 3 weeks of placement, 12 IVCFs were retrieved. Of the remaining eight patients, six had indications for permanent implantation, two had contralateral deep venous thrombosis, and one had ipsilateral deep venous thrombosis. CONCLUSION: Bedside insertion of a removable IVCF with IVUS guidance and its removal are simple, safe, and accurate.     

Prosthetic replacement of the superior vena cava treated with antiplatelet agents

The effects of cepharanthin and dipyridamole depot capsules (RAD) on the fate of Teflon fluorocarbon resin grafts used for replacement of the canine superior vena cava were studied. After short-term observation of 11 implanted grafts, 57 adult mongrel dogs underwent superior vena caval replacement with these Teflon grafts. Cepharanthin (2 mg/kg daily) and RAD (10 mg/kg daily) were administered after surgery to 28 and 14 animals, respectively. Dogs were killed at 12 days to 6 months after graft implantation. Fifteen dogs served as controls. In the cepharanthin-treated group, three grafts exhibited luminal obstruction with severe intimal hyperplasia, but smooth, semitransparent thin neointima was recognized in 25. The endothelial cell lining of the neointima exhibited excellent spread 2 months after implantation. Although one graft was obstructed with hyperproliferative fibrosis in the RAD-treated group, a well-developed neointima with complete coverage of endothelial cells was confirmed in 14 dogs. With regard to the rate of occurrence of luminal obstruction, these data were significantly different from those of the control group, which suggests that intimal hyperplasia can be reduced by treatment with antiplatelet agents.     

下腔静脉滤器置入术98例临床分析

目的 探讨下腔静脉滤器(IVCF)应用的适应证及其并发症的预防.方法 对98例行IVCF置入术的患者的临床资料进行回顾性分析.结果 本组98例患者IVCF均一次性置人成功,其中放置永久性滤器86例,临时性滤器12例.82例(83.7%)患者获得随访,随访时间1～11个月,未出现肺栓塞(PE);3例(3.5%)放置永久性...     

Role of prophylactic temporary inferior vena cava filters placed at the ICU bedside under intravascular ultrasound guidance in patients with multiple trauma

OBJECTIVE: Patients with multiple trauma often have injuries that preclude the use of anticoagulation therapy or sequential compression device prophylaxis. Temporary inferior vena cava (IVC) filters (IVCFs) offer protection against pulmonary embolism during the early immediate injury and perioperative period, when risk is highest, while averting potential long-term sequelae of permanent IVCFs. The objective of this study was to evaluate the efficacy of prophylactic, temporary IVCF placement at the intensive care unit bedside under real-time intravascular ultrasound (IVUS) guidance in patients with multiple trauma. INTERVENTIONS: Ninety-four patients with multiple trauma seen between July 1, 2002, and November 1, 2003, underwent placement of OptEase (Cordis Endovascular) retrievable IVCFs under real-time IVUS guidance. Mean (+/-SD) Injury Severity Score was 25.1 +/- 2.2). Abdominal x-ray films were obtained in all patients to verify filter location. Before IVCF retrieval all patients underwent femoral vein color-flow ultrasound scanning to rule out deep vein thrombosis (DVT), and pre-procedure and post-procedure vena cavography to identify possible IVCF thrombus entrapment and post-retrieval inferior vena cava injury. RESULTS: Nineteen patients died of their injuries; no deaths were related to IVCF placement. One pulmonary embolism occurred during follow-up after filter retrieval, and 1 insertion site femoral vein DVT occurred. As verified on abdominal x-ray films, 96.8% (91 of 94) of IVCFs were placed without complications at the L2-3 level. Filter-related complications included 2 groin hematomas (2.1%) and 3 IVCFs misplaced in the right iliac vein (3.2%), early in our experience; the filters were uneventfully retrieved and replaced in the inferior vena cava within 24 hours. Thirty-one patients underwent uneventful retrieval of IVCFs after DVT or pulmonary embolism anticoagulation prophylaxis was initiated. Forty-four filters were not removed, 41 because severity of injury prevented DVT or pulmonary embolism prophylaxis and 3 because of thrombus trapped within the filter. CONCLUSIONS: Prophylactic, temporary IVCF placement at the intensive care unit bedside under IVUS guidance in patients with multiple trauma is simple and safe, and serves as an effective "bridge" to anticoagulation therapy until venous thromboembolism prophylaxis can be initiated. Further investigation of this bedside technique and the role of temporary IVCFs in patients with multiple trauma is warranted. CLINICAL RELEVANCE: Patients with multiple trauma often have injuries that preclude the use of anticoagulation therapy or sequential compression device prophylaxis. Temporary inferior vena cava filters (IVCFs) offer protection against pulmonary embolism during the perioperative and immediate injury period, when risk is highest. Ninety-four patients with multiple trauma underwent prophylactic, temporary IVCF placement at the intensive care unit bedside under real-time intravascular ultrasound. One pulmonary embolism occurred during follow-up after filter retrieval, and 1 insertion site femoral vein deep venous thrombosis occurred. Ninety-one of 94 IVCFs (96.8%) were placed without complication. Thirty-one patients underwent uneventful retrieval of IVCFs after anticoagulation prophylaxis was initiated. Forty-four filters were not removed, because of severity of injury (n = 41) or because of trapped thrombus within the filter (n = 3). Prophylactic, temporary IVCFs placed under intravascular ultrasound guidance at the bedside in patients with multiple trauma is simple, safe, and an effective bridge to anticoagulation therapy.